2014 Safe Routes to School Pilot Bicycle Fleet Solicitation
Application Form:
Please fill out this form to apply for a bike fleet and trailer. See the application packet for more details.
School/Organization Information
Applicant name:
School names:
City:
County:
Contact Information
Primary contact name:
Telephone number:
Email address:
Mailing address:
SRTS Program Information
Does this school have a SRTS plan?
Briefly describe existing SRTS activities (SHIP school support, Walk! Bike! Fun! Curriculum taught, SRTS planning, annual evaluation with student hand tallies etc.) at this school (Limit 250 words):
Please list the namesof people and organizations that champion SRTS in the communities that will be served.
School Questions
How many students will benefit from the use of the bicycle fleet?
Please list the schools that will use the bicycle fleet, include:
- the grades and number of students who will use the fleet at each school or organization
- the number of students within two miles of each school
- the number of students who qualify for free and reduced lunch
Please list the other organizations who will use the bicycle fleet and the number of youth they expect will use the bicycle fleet.
School or Organization / Grade level/Age / # Students or youth reached / # Students 2 miles from school* / # Students free/reduced lunch*TOTAL
*Schools only
Bike Fleet Questions
Briefly describe your plan for storing, scheduling, sharing and moving the bikes to schools and other organizations. (Limit 500 words)
Briefly describe your plan to maintain the bicycle fleet for at least 5 years. Estimated annual parts and service are anticipated to range from $2,000-4,000. (Limit 250 words)
Evaluation Questions
Successful applicants will be required to collect surveys about student travel behavior and hand tallies on how students travel to school.
Is your school willing to assist in collecting this data? ___ Yes___ No
Is your school currently collecting this data or evaluating additional SRTS activities? (working with SHIP, previous MnDOT grants, other ) ___ Yes ___ No
Able to meet grant requirements?___ Yes___ No
School Administrator Resolution
Along with these questions, submit a resolution of support to enter into a contract from the school board or other governing body to meet the state program requirements. An example will be posted on the SRTS website with this application packet.
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