+--------+-----+---+---------------------------------------------------+
| **     |     |   |                                                   |
| [TITLE |     |   |                                                   |
| VI     |     |   |                                                   |
| PRE    |     |   |                                                   |
| -AWARD |     |   |                                                   |
| SPON   |     |   |                                                   |
| SOR]{. |     |   |                                                   |
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| **[    |     |   |                                                   |
| CHECKL |     |   |                                                   |
| IST]{. |     |   |                                                   |
| underl |     |   |                                                   |
| ine}** |     |   |                                                   |
+--------+-----+---+---------------------------------------------------+
| **     |     | * |                                                   |
| Airpor |     | * |                                                   |
| t/Spon |     |   |                                                   |
| sor:** |     |   |                                                   |
|        |     |   |                                                   |
|        |     |   |                                                   |
|        |     |   |                                                   |
|        |     | * |                                                   |
|        |     | * |                                                   |
+--------+-----+---+---------------------------------------------------+
| **AIP  | **  |   |                                                   |
| #:**   |     |   |                                                   |
|        |  ** |   |                                                   |
+--------+-----+---+---------------------------------------------------+
| **P    |     |   | **     **                                         |
| roject |     |   |                                                   |
| Descr  |     |   |                                                   |
| iption |     |   |                                                   |
| (s):** |     |   |                                                   |
+--------+-----+---+---------------------------------------------------+
| 1)  ** |     |   |                                                   |
| Please |     |   |                                                   |
|     de |     |   |                                                   |
| scribe |     |   |                                                   |
|        |     |   |                                                   |
|    any |     |   |                                                   |
|     of |     |   |                                                   |
|        |     |   |                                                   |
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|        |     |   |                                                   |
|    fol |     |   |                                                   |
| lowing |     |   |                                                   |
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|        |     |   |                                                   |
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|        |     |   |                                                   |
|   your |     |   |                                                   |
|     pr |     |   |                                                   |
| oject: |     |   |                                                   |
|        |     |   |                                                   |
|  Title |     |   |                                                   |
|     VI |     |   |                                                   |
|        |     |   |                                                   |
| issues |     |   |                                                   |
|        |     |   |                                                   |
| raised |     |   |                                                   |
|     at |     |   |                                                   |
|        |     |   |                                                   |
| public |     |   |                                                   |
|        |     |   |                                                   |
|   hear |     |   |                                                   |
| ing(s) |     |   |                                                   |
|        |     |   |                                                   |
|    and |     |   |                                                   |
|        |     |   |                                                   |
|    the |     |   |                                                   |
|        |     |   |                                                   |
|  concl |     |   |                                                   |
| usions |     |   |                                                   |
|        |     |   |                                                   |
|  made; |     |   |                                                   |
|        |     |   |                                                   |
|    EIS |     |   |                                                   |
|        |     |   |                                                   |
|   data |     |   |                                                   |
|        |     |   |                                                   |
|   conc |     |   |                                                   |
| erning |     |   |                                                   |
|        |     |   |                                                   |
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|        |     |   |                                                   |
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|     or |     |   |                                                   |
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|        |     |   |                                                   |
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|        |     |   |                                                   |
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|        |     |   |                                                   |
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| gainst |     |   |                                                   |
|        |     |   |                                                   |
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| essary |     |   |                                                   |
|        |     |   |                                                   |
| impact |     |   |                                                   |
|     on |     |   |                                                   |
|     p  |     |   |                                                   |
| ersons |     |   |                                                   |
|     on |     |   |                                                   |
|        |     |   |                                                   |
|    the |     |   |                                                   |
|        |     |   |                                                   |
|  basis |     |   |                                                   |
|     of |     |   |                                                   |
|        |     |   |                                                   |
|  race, |     |   |                                                   |
|        |     |   |                                                   |
|  color |     |   |                                                   |
|     or |     |   |                                                   |
|     na |     |   |                                                   |
| tional |     |   |                                                   |
|        |     |   |                                                   |
|    ori |     |   |                                                   |
| gin.** |     |   |                                                   |
|        |     |   |                                                   |
| >      |     |   |                                                   |
| > **   |     |   |                                                   |
| None** |     |   |                                                   |
| >      |     |   |                                                   |
| > **   |     |   |                                                   |
|     ** |     |   |                                                   |
|        |     |   |                                                   |
| 2)  ** |     |   |                                                   |
| Please |     |   |                                                   |
|        |     |   |                                                   |
|   list |     |   |                                                   |
|        |     |   |                                                   |
|    any |     |   |                                                   |
|     a  |     |   |                                                   |
| irport |     |   |                                                   |
|     r  |     |   |                                                   |
| elated |     |   |                                                   |
|        |     |   |                                                   |
|  Title |     |   |                                                   |
|     VI |     |   |                                                   |
|     la |     |   |                                                   |
| wsuits |     |   |                                                   |
|     or |     |   |                                                   |
|        |     |   |                                                   |
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| laints |     |   |                                                   |
|        |     |   |                                                   |
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|        |     |   |                                                   |
|    the |     |   |                                                   |
|        |     |   |                                                   |
|    pre |     |   |                                                   |
| ceding |     |   |                                                   |
|        |     |   |                                                   |
|   year |     |   |                                                   |
|     a  |     |   |                                                   |
| gainst |     |   |                                                   |
|        |     |   |                                                   |
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|     sp |     |   |                                                   |
| onsor. |     |   |                                                   |
|     I  |     |   |                                                   |
| nclude |     |   |                                                   |
|     a  |     |   |                                                   |
|     s  |     |   |                                                   |
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|     of |     |   |                                                   |
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|        |     |   |                                                   |
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| one\", |     |   |                                                   |
| > co   |     |   |                                                   |
| ntinue |     |   |                                                   |
| > with |     |   |                                                   |
| > que  |     |   |                                                   |
| stions |     |   |                                                   |
| > 3    |     |   |                                                   |
| > and  |     |   |                                                   |
| > 4).  |     |   |                                                   |
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| >      |     |   |                                                   |
| > **   |     |   |                                                   |
|     ** |     |   |                                                   |
|        |     |   |                                                   |
| 3)  ** |     |   |                                                   |
| Please |     |   |                                                   |
|        |     |   |                                                   |
|   list |     |   |                                                   |
|        |     |   |                                                   |
|    any |     |   |                                                   |
|     c  |     |   |                                                   |
| urrent |     |   |                                                   |
|        |     |   |                                                   |
| applic |     |   |                                                   |
| ations |     |   |                                                   |
|        |     |   |                                                   |
|    for |     |   |                                                   |
|     f  |     |   |                                                   |
| ederal |     |   |                                                   |
|     f  |     |   |                                                   |
| unding |     |   |                                                   |
|        |     |   |                                                   |
| (other |     |   |                                                   |
|        |     |   |                                                   |
|   than |     |   |                                                   |
|        |     |   |                                                   |
|   FAA) |     |   |                                                   |
|     of |     |   |                                                   |
|     a  |     |   |                                                   |
| irport |     |   |                                                   |
|     r  |     |   |                                                   |
| elated |     |   |                                                   |
|     pr |     |   |                                                   |
| ojects |     |   |                                                   |
|        |     |   |                                                   |
|  which |     |   |                                                   |
|        |     |   |                                                   |
| exceed |     |   |                                                   |
|        |     |   |                                                   |
|    the |     |   |                                                   |
|        |     |   |                                                   |
| amount |     |   |                                                   |
|        |     |   |                                                   |
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|     ** |     |   |                                                   |
|        |     |   |                                                   |
| 4)  ** |     |   |                                                   |
| Please |     |   |                                                   |
|        |     |   |                                                   |
|   list |     |   |                                                   |
|        |     |   |                                                   |
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| elated |     |   |                                                   |
|        |     |   |                                                   |
|  Title |     |   |                                                   |
|     VI |     |   |                                                   |
|        |     |   |                                                   |
|   comp |     |   |                                                   |
| liance |     |   |                                                   |
|        |     |   |                                                   |
|    rev |     |   |                                                   |
| iew(s) |     |   |                                                   |
|     re |     |   |                                                   |
| ceived |     |   |                                                   |
|     by |     |   |                                                   |
|        |     |   |                                                   |
|    the |     |   |                                                   |
|     s  |     |   |                                                   |
| ponsor |     |   |                                                   |
|     in |     |   |                                                   |
|        |     |   |                                                   |
|    the |     |   |                                                   |
|        |     |   |                                                   |
|    pre |     |   |                                                   |
| ceding |     |   |                                                   |
|        |     |   |                                                   |
|    two |     |   |                                                   |
|        |     |   |                                                   |
| years. |     |   |                                                   |
|     I  |     |   |                                                   |
| nclude |     |   |                                                   |
|        |     |   |                                                   |
|    who |     |   |                                                   |
|        |     |   |                                                   |
|    con |     |   |                                                   |
| ducted |     |   |                                                   |
|        |     |   |                                                   |
|    the |     |   |                                                   |
|        |     |   |                                                   |
| review |     |   |                                                   |
|        |     |   |                                                   |
|    and |     |   |                                                   |
|        |     |   |                                                   |
|    any |     |   |                                                   |
|     fi |     |   |                                                   |
| ndings |     |   |                                                   |
|     of |     |   |                                                   |
|        |     |   |                                                   |
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| omplia |     |   |                                                   |
| nce.** |     |   |                                                   |
|        |     |   |                                                   |
| >      |     |   |                                                   |
| > **   |     |   |                                                   |
| None** |     |   |                                                   |
| >      |     |   |                                                   |
| > **   |     |   |                                                   |
|     ** |     |   |                                                   |
+--------+-----+---+---------------------------------------------------+
| **To   |     |   |                                                   |
| be     |     |   |                                                   |
| com    |     |   |                                                   |
| pleted |     |   |                                                   |
| by the |     |   |                                                   |
| Civil  |     |   |                                                   |
| Rights |     |   |                                                   |
| S      |     |   |                                                   |
| taff** |     |   |                                                   |
|        |     |   |                                                   |
| **     |     |   |                                                   |
| Review |     |   |                                                   |
| com    |     |   |                                                   |
| pleted |     |   |                                                   |
| and    |     |   |                                                   |
| app    |     |   |                                                   |
| roved: |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_** |     |   |                                                   |
|        |     |   |                                                   |
| *      |     |   |                                                   |
| *Signa |     |   |                                                   |
| ture** |     |   |                                                   |
|        |     |   |                                                   |
| #      |     |   |                                                   |
| # Date |     |   |                                                   |
| : \_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
| \_\_\_ |     |   |                                                   |
+--------+-----+---+---------------------------------------------------+
| This   |     |   |                                                   |
| che    |     |   |                                                   |
| cklist |     |   |                                                   |
| is     |     |   |                                                   |
| only   |     |   |                                                   |
| re     |     |   |                                                   |
| quired |     |   |                                                   |
| for    |     |   |                                                   |
| pr     |     |   |                                                   |
| ojects |     |   |                                                   |
| that   |     |   |                                                   |
| i      |     |   |                                                   |
| nvolve |     |   |                                                   |
| one of |     |   |                                                   |
| the    |     |   |                                                   |
| foll   |     |   |                                                   |
| owing: |     |   |                                                   |
| E      |     |   |                                                   |
| nviron |     |   |                                                   |
| mental |     |   |                                                   |
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| or     |     |   |                                                   |
| Impact |     |   |                                                   |
| Sta    |     |   |                                                   |
| tement |     |   |                                                   |
| (EIS); |     |   |                                                   |
| a      |     |   |                                                   |
| irport |     |   |                                                   |
| or     |     |   |                                                   |
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| ation; |     |   |                                                   |
| major  |     |   |                                                   |
| runway |     |   |                                                   |
| exte   |     |   |                                                   |
| nsion; |     |   |                                                   |
| relo   |     |   |                                                   |
| cation |     |   |                                                   |
| of any |     |   |                                                   |
| str    |     |   |                                                   |
| ucture |     |   |                                                   |
| of     |     |   |                                                   |
| p      |     |   |                                                   |
| erson; |     |   |                                                   |
| or     |     |   |                                                   |
| impact |     |   |                                                   |
| to     |     |   |                                                   |
| access |     |   |                                                   |
| or     |     |   |                                                   |
| preser |     |   |                                                   |
| vation |     |   |                                                   |
| of any |     |   |                                                   |
| burial |     |   |                                                   |
| cere   |     |   |                                                   |
| monial |     |   |                                                   |
| or     |     |   |                                                   |
| other  |     |   |                                                   |
| sacred |     |   |                                                   |
| or     |     |   |                                                   |
| hist   |     |   |                                                   |
| orical |     |   |                                                   |
| stru   |     |   |                                                   |
| ctures |     |   |                                                   |
| or     |     |   |                                                   |
| lands  |     |   |                                                   |
| of any |     |   |                                                   |
| indi   |     |   |                                                   |
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| or     |     |   |                                                   |
| ethnic |     |   |                                                   |
| popul  |     |   |                                                   |
| ation. |     |   |                                                   |
|        |     |   |                                                   |
| **     |     |   |                                                   |
| Return |     |   |                                                   |
| to:    |     |   |                                                   |
| FAA,   |     |   |                                                   |
| Civil  |     |   |                                                   |
| R      |     |   |                                                   |
| ights, |     |   |                                                   |
| Nor    |     |   |                                                   |
| thwest |     |   |                                                   |
| Mo     |     |   |                                                   |
| untain |     |   |                                                   |
| R      |     |   |                                                   |
| egion; |     |   |                                                   |
| 1601   |     |   |                                                   |
| Lind   |     |   |                                                   |
| Ave.   |     |   |                                                   |
| SW;    |     |   |                                                   |
| R      |     |   |                                                   |
| enton, |     |   |                                                   |
| WA     |     |   |                                                   |
| 98055  |     |   |                                                   |
| -4056. |     |   |                                                   |
| FAX:   |     |   |                                                   |
| (425)  |     |   |                                                   |
| 22     |     |   |                                                   |
| 7-1009 |     |   |                                                   |
| Phone  |     |   |                                                   |
| (425)  |     |   |                                                   |
| 227-   |     |   |                                                   |
| 2009** |     |   |                                                   |
+--------+-----+---+---------------------------------------------------+
|        |     |   |                                                   |
+--------+-----+---+---------------------------------------------------+