| Part I |
| Applicant Information |
| *
Name of Applicant |
|
| Point of Contact Information |
| *
First Name |
|
| *
Last Name |
|
| Title |
|
| *
Agency/Organization |
|
| *
Address 1 |
|
| Address 2 |
|
| *
City |
|
| *
State |
|
| *
ZIP |
|
| *
Phone |
|
| Fax |
|
| *
Email |
|
| Part II |
| Community Information |
| *
Does your community participate in
NFIP? |
Yes
No
|
| *
Does your community have a local
mitigation plan? |
Yes
No
|
| Enter the Latitude and Longitude coordinates
for the community. |
| Latitude: |
|
| Longitude: |
|
| Project Information |
| *
Description of problem to be solved |
|
| *
Location of project |
|
| *
Brief description of alternatives under
consideration |
|
| *
Total estimated cost |
|
| *
Source of matching funds |
|