MISSOURI STATE BLOCK GRANT APPLICATION
(Federal Funds-95%) /

Date

Airport Name

Sponsor Name / County
Address / Phone
City, State, Zip / Fax
E-Mail Address
Contact Person’s Name / Title
Address / Phone
City, State, Zip / Fax
E-Mail Address
Proposed Project Funding
State block grant funds are federal funds administered by the state of Missouri, which are currently granted on the basis of 95% of the approved cost.

Breakdown of Local Amount

/

Project Costs

Cash. Amount on deposit in airport account prior to execution of grant agreement will be at least $. / Total estimated project costs / $
Federal Amount (95%) / $
Local Amount (5%) / $

Project Description

Proposed Construction:
Other Proposed Improvements:
Project Readiness
/
Yes
/
No
Development is shown on an approved Airport Layout Plan (ALP). Date approved by MoDOT or FAA (circle one):
Sponsor owns sufficient land for project.
Current Exhibit “A” Property Map/Certificate of Title.
Design plans ready for bidding.
Number of based aircraft. / Single Engine / Twin / Jet
Number of annual operations (An operation is either a takeoff or a landing).

Sponsor’s Representative

Typed or Printed Name and Title
/
Signature

PLEASE MAIL COMPLETED APPLICATION TO:

MISSOURI DEPARTMENT OF TRANSPORTATION

AVIATION SECTION-MO

P.O. BOX 270

JEFFERSON CITY, MO 65102

FOR MoDOT USE ONLY

Facilities inspected by: / Date:
Project considered: / Emergency / Routine
/
Yes
/
No
Project qualifies as a Categorical Exclusion.
EA underway for FONSI.
EIS complete awaiting FAA approval.
Sponsor certifies sufficient local funds.
Project Readiness Score: / Proposed Funding Year
Recommended: / Disapproved / Approved
Reason(s) for recommending disapproval: ______
______
______
______
______

Rev. 11/01/05