APPENDIX C

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SMALL COMMUNITY AIR SERVICE DEVELOPMENT PROGRAM

DOCKET OST-2011-0119

SUMMARY INFORMATION

All applicants must submit this information with their proposal, along with a completed form SF424 on http:// 

www.grants.gov. 

A. APPLICANT INFORMATION: (CHECK ALL THAT APPLY)

⁭X Not a Consortium ⁭ Interstate Consortium ⁭ Intrastate Consortium

⁭ Community now receives EAS subsidy

⁭X Community (or Consortium member) previously received a Small Community Grant

If previous recipient: Date of Grant: 09/20/02 Expiration date of grant: 02/28/05

 Date of Grant: 01/31/08 Expiration date of grant: 06/10/10

B. PUBLIC/PRIVATE PARTNERSHIPS: (LIST ORGANIZATION NAMES)

Public Private

1. ___________________________________ 1.______________________________________

 2.____________________________________ 2.______________________________________

 3.____________________________________ 3.______________________________________

 4.____________________________________ 4.______________________________________

 5.____________________________________ 5.______________________________________

C. PROJECT PROPOSAL: (CHECK ALL THAT APPLY)

⁭ Marketing ⁭ Upgrade Aircraft ⁭ X New Route

⁭ Travel Bank ⁭ Service Restoration ⁭ Subsidy

⁭ Surface Transportation ⁭ Regional Service Revenue Guarantee ⁭

X Launch New Carrier Start Up Cost Offset First Service

Study ⁭ Secure Additional Carrier Other (explain below)

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 APPENDIX C

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⁭

D. EXISTING LANDING AIDS AT LOCAL AIRPORT:

⁭ X Full ILS ⁭ Outer/Middle Marker ⁭ X Published Instrument Approach

⁭ X Localizer ⁭ Other (specify)

E. PROJECT COSTS: DO NOT ENTER TEXT IN SHADED AREA

LINE DESCRIPTION SUB TOTAL TOTAL AMOUNT

1 Federal amount requested $500,000

2 State cash financial contribution $0

Local cash financial contribution

3a Airport cash funds $15,000

3b Non-airport cash funds $0

3 Total local cash funds (3a +3b) $15,000

4 TOTAL CASH FUNDING (1+2+3) $515,000

In-Kind contribution

5a Airport In-Kind contribution** $40,000

5b Other In-Kind contribution** $0

5 TOTAL IN-KIND CONTRIBUTION

(5a + 5b)

$40,000

6 TOTAL PROJECT COST (4+8) $555,000

F. IN-KIND CONTRIBUTIONS**

For funds in lines 5a (Airport In-Kind contribution) and 5b (Other In-Kind contribution), please describe the 

source(s) of fund(s) for each.

Airport billboard sign for 12 months; Waiver of landing fees for 3 months; Waiver of lease fees for 3 months
APPENDIX C

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G. IS THIS APPLICATION SUBJECT TO REVIEW BY STATE UNDER EXECUTIVE ORDER 12372 PROCESS?

⁭ a. This application was made available to the State under the Executive Order 12372 Process for review on

(date)___________________.

⁭ b. Program is subject to E.O. 12372, but has not been selected by the State for review.

⁭ X c. Program is not covered by E.O. 12372.

H. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? (IF “YES”, PROVIDE EXPLANATION)

⁭ X No ⁭ Yes (explain) 

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