Broadband Technical Assistance Application Form

Broadband Technical Assistance Funding Application
1. Basic information

Please fill out the below information.
Project Title:
Total Project Funding Requested:
County/Fiscal Agent:
Primary Project Leader's Full Name

First NameMiddle Initial Last Name
Company Name
Phone Number
E-mail
example@example.com
Co-Project Leader's Full Name

First NameMiddle Initial Last Name
Company Name
Phone Number
E-mail
example@example.com
Co-Project Leader's Full Name

First NameMiddle Initial Last Name
Company Name
Phone Number
E-mail
example@example.com
Co-Project Leader's Full Name

First NameMiddle Initial Last Name
Company Name
Phone Number
E-mail
example@example.com
Describe any contracts, collaborations or partnerships with other agencies or counties involved in this project. If you are not working with any other agency or do not have any subcontractors to support the work, please indicate that you will need assistance with that and to what extent.

2. Project Details

Please answer the questions to the best of your ability.
2a. Describe the overall scope and goals of the project. You may summarize here if you have other documents prepared that you will upload that explain in detail your project.
2b. How does your scope fit with the approved scope of work approved for funding? Please indicate which of the eligible criteria your proposal is aligned with.
2c. Describe any actions and deliverables you've already accomplished related to this project.
2d. Will the funding amount requested be enough to fully complete your project and explain the gap if not? Describe other funding being used to support this project. If your request does not get fully funded, describe the impact it will have on starting or completing this project.

3. Additional Information

Please follow the below instructions.
Please upload any documents related to this request. Also, please upload any current contracts you have that pertain to this request.
File Upload

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4. Project Budget
Include all budget items for which funding is being requested. Include any other funding being used to complete the project. Please be as detailed as possible.
Upload your project budget:

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Completing the Application

Fill the checkbox in below and make sure everything in the form is filled out properly.
Checklist. Make sure you do ALL of these things. Please double check your form.

Did you provide a Project Title?Did you provide contact information for the project partners?Did you complete all of the questions?Did you upload a budget?
Should be Empty:

Broadband Technical Assistance Funding Application