Community Preservation Committee

55 Main Street

Westford, Massachusetts 01886

TEL (978) 692-5524 FAX (978) 399-2558

Westford Community Preservation Funding Application

Project Submission Form

Basic Project Information:

Submission Date: _______________________________________________

Project Name: __________________________________________________

CPA funds requested: $___________________________________________

Applicant:

Name ___________________________________________________

Address __________________________________________________

Phone Mail _______________________________________________

Email ___________________________________________________

Sponsoring board/committee(s) _______________________________

________________________________________________________

Additional responsible parties – i.e. Property owner, consultant (if applicable)

________________________________________________________

Project manager/contact person:

Purpose: (please select all that apply)

¨ Open Space

¨ Affordable Housing

¨ Historic Preservation

¨ Recreation

Project location/address:

Assessor information: (map/block/lot id) as applicable:

Ownership/care and custody information:

Deed restrictions required:

¨ Conservation

¨ Housing

¨ Historic Preservation

Budget:

Complete budget (attach as necessary)

Percent of total budget requested from Community Preservation funds:

Other funding sources (committed/applied/planned):

Anticipated annual income/expenses:

Recurring expenses (i.e. Maintenance):

Taxpayer impact:

Timeline:

Proposed Start Date: _____________________________________________

Proposed Completion Date: ________________________________________

Endorsement by applicable boards/commissions/community groups:

¨ Affordable Housing Committee and/or Housing Authority

¨ Cemetery Commission

¨ Conservation Commission

¨ Historic Commission

¨ Parks and Recreation Commission

¨ Planning Board

¨ Water Commission

¨ Other

Project Description and Goals:

Please describe project. In proposal, please include how this project impacts Westford’s citizens and addresses Westford’s current and/or future needs? How does this project preserve Westford’s character and meet its preservation goals? Why should this project be funded this year? (Use as many additional pages as necessary)

If this application is submitted outside of the usual funding cycle, please explain why.

List of Attachments: (including but not limited to photos, plans, maps, quotes, costs, estimates, letters of endorsement)

Applicant Signatures/Date

For Community Preservation Committee Use Only

Date received: __________________________________________________

Copies distributed on: ____________________________________________

Is sufficient data/detail provided? ___________________________________

Is timeliness an issue? ____________________________________________

Is additional information required? __________________________________

_____________________________________________________________

Project interview date: ___________________________________________

Public hearing date: _____________________________________________

Committee vote:

Yes ______________________

No ______________________

Abstain ___________________

Date _____________________

Recommendation from Committee:

Recommended for Town Meeting consideration:

Spring ____________________

Fall ______________________

Special ___________________

Year _____________________