INDIAN NATIONS COUNCIL OF GOVERNMENTS
(INCOG)

Rural Economic Action Plan (REAP) Application

COMMUNITY DEVELOPMENT - FY 2023

I.	APPLICANT INFORMATION

A.	Name:	 	 County:	 	 

B.	Address:	 		Phone:	 	 

		 		Email:_________________________
 
C.    Applicant’s Chief Elected Official: 		 					 

D.	 Applicant's Contact Person (if other than chief elected official):

       Name:		 

       Address:			Phone:		 

       E-mail: _____________________________

E.	Population (for City/Town/Unincorporated Area of County): 	 	 
		(Based on most recent Decennial Census information)

	Total number of people benefiting from project: __________________________

II.	PROJECT INFORMATION:

A.	Detailed Project Description (refer to the description in your engineering report or detailed budget for assistance) : 	   
			 
B.	Project Location (attach map of target area):	 
			 
C.	Amount of Grant Request (REAP $): ____________________________________________   
	Total Project Cost (all sources of funding): ________________________________________
D.	Anticipated Project Start Date (Assume contract award Jan 2023, # of days after contract award): _________________________________       
E.	Detailed Project Budget (Form attached)                                           
F.	    Attach cost estimate(s) (ex. Catalog pages, Engineering Estimate, County Quote, other quotes, etc.).
G.	Check all items (that apply) and have been accomplished to date: 
___ Engineering Report or Cost Estimate	
___ Quotes	
___ Other ________________________		

III.	REGIONAL OBJECTIVES (2 pts each)

A.  Does the project promote public health and safety? (Including do you have a Consent Order or Notice of Violation?)  qYes qNo If yes, please explain and provide a copy of the Consent Order or Notice of Violation, if applicable.. 
______________________________________________________________________________________________________________________________________________________________________________________________________________________________

B.  Does the project enhance economic development (e.g. adds permanent jobs, brings in new business)?   qYes qNo If yes, please explain: 
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

C.  Does the project promote intergovernmental cooperation?  qYes qNo If yes, please explain:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
D.  Is the project included in regional or local plans such as a comprehensive plan, strategic plan, capital improvement plan (CIP), hazard mitigation plan or similar plans? 
qYes qNo If yes, please provide documentation and list the name of the plan.
________________________________________________________________________________________________________________________________________________________________

IV.	PROJECT IMPACT (Up to 15 points total)

A.	Explain Health and Safety Impact (e.g. Water/sewer line improvements, emergency preparedness, fire projects, etc.):	
_______________________________________________________________________________		

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

B.	Please describe any other impacts your project may have: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 V.	LOCAL EFFORT (not required, but up to 5 points are awarded for match)
	
A.	Please describe additional local resources such as local funds, labor and materials, etc. and list below. (including Community/ County labor and equipment) 
	_______________________________________________________________________________

	_______________________________________________________________________________

	_______________________________________________________________________________

	_______________________________________________________________________________

	_______________________________________________________________________________

B.	              Non-REAP Source*                                           Non-REAP Funding Amount	

			 

*Sources may be local funds, other grant funds, volunteer labor (list # of hours at $10/hour) or donated materials (give actual or estimated worth).