Fillable SignsAndLines Appl Signs and Lines Application

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SignsAndLines Appl Signs and Lines Application

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The SignsAndLines Appl Signs and Lines Application form is 2 pages long and contains:

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  • 35 other fields

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File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Safe Routes to School (SRTS)
Signs and Lines Program
2019-2020 Project Application
1. Name of Applicant School:
2. Municipal Applicant Contact:
3. Title/Role:
4. Phone Number:
5. Email Address:
6. Address:
7. Address 2:
8. Town/City:
9. Zip Code:
10. School Applicant Contact:
11. Title/Role:
12. Phone Number:
13. Email Address:
14. Address:
15. Address 2:
16. Town/City:
17. Zip Code:
1. Are you a Safe Routes to
School Partner?
2. Partnership level (2018-2019
School Year):
3. Describe your involvement
with the SRTS program:
1. Grades Served 2. Total Number of Students
3. Number of Daily Walkers 4. Number of Daily Bikers
7. How many more walkers and
bikers will you see as a result of
this project?
8. Please describe the school and
municipal support of this project:
You may include letters of support with this
application
A. School and Municipality Applicant Information
B. Safe Routes to School Partnership Information
C. Project Information
5. Describe the project: You may
include one additional page with a map and/
or photos
6. How would this project benefit
your students?
Page 1 of 2
Safe Routes to School (SRTS)
Signs and Lines Program
2019-2020 Project Application
Name of Applicant School:
School Applicant Signature Date
Municipal Applicant Signature Date
Internal use only:
Information reviewed and confirmed by SRTS
Date Joined SRTS Program:
Partnership Level (if available):
Application received on date:
SRTS Outreach Coordinator:
Signature:
We understand that this is a reimbursement-based project and that the municipality must pay for all costs in advance.
If our project is selected, we agree to adhere to all the terms and conditions of the Memorandum of Understanding (MOU) and
sign the MOU prior to beginning any project-related tasks.
We have read through the Signs and Lines Guidance Document and understand the process and timeline of all project-related
tasks.
If our project is selected, we agree to complete all work within the current school year, no later than June 30.
If our project is selected, we agree to submit an invoice for work completed not to exceed $6,000 and no later than July 15 of
the school year where the project was completed.
I am authorized to sign below and commit resources on behalf of the municipality.
Please email completed form to SRTS@dot.state.ma.us or fax to 857-368-0656
Page 2 of 2
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SignsAndLines Appl Signs and Lines Application

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Completed 21 March 2020

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