Alabama Department of Transportation



APPLICATION COVER PAGE

Section A

Alabama Department of Transportation

FY 20  

Safe Routes to School Application

(Submit 5 original applications)

Legal Name of Agency:       County:_____________

Address of Agency:

     

Street

     

City, State, Zip

Alabama Legislative Jurisdiction: House:       Senate:      

Agency Contact Information:

Name:      

Title:      

Telephone Number: (   )    -     Ext.     

Fax Number: (   )    -    

E-mail Address:      

Type of Application

(Please check one): Infrastructure Non-Infrastructure Combined

Name of Schools Impacted: School District:     ____________

     

     

     

TOTAL FUNDS REQUESTED: $      

(Max Amount is $150,000)

Section B

Safe Routes to School (SRTS) Application Checklist

The following items MUST BE included in the application to be submitted to the Department of Transportation and labeled in the following order:

[A] Application Cover Page

[B] Application Checklist

[C] Minutes of Community SRTS Work Team Meeting(s)

[D] Minutes of Community Public Meeting(s)

[E] SRTS Assessment Form (SRTSAF)

[F] Project Identification Form

[G] Line Item Budgets

[H] Scope of Work

[I] Map and or Drawing of the Project Area (infrastructure project)

[J] Pictures highlighting the need for Infrastructure Projects

[K] Details of Non-Infrastructure Projects

[L] Letters of Support

The following must be submitted separately to the Department of Public Health.

[M] Parent Surveys

[N] Classroom Tally sheets

Note: Only one copy of the parent surveys and tally sheets should be submitted. Fax these to (334) 206-2059 or mail to:

Attn: Adrinda Carter

Safe Routes to School

Alabama Department of Public Health

201 Monroe Street Suite 980E

Montgomery, AL 36104

Section E

Neighborhood SRTS Assessment Form

BASELINE DATA

|School Name:       |Enrollment:       |

|No. Current Walkers:       |No. Current Bikers:       |

|No. Current Parent Carpools:       |No. Active Highway Safety Programs:       |

|% of Parent Surveys Returned:     |No. Classroom Tally Sheets Completed:       |

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DOCUMENTED PROBLEMS

|Problems Identified: |Crash Data Results: |

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| |Police Records:       |

| | Other:       |

PROJECTED OUTCOMES/GOALS

|No. New Walkers:       |No. New Bikers:       |

|No. Educational programs:       |No. Volunteers recruited:       |

|No. Community groups involved:       |No. of Walk to School Day activities:      Go to |

| | to register your events |

Section F

SRTS Project Identification Form

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| |City/County:       |School:       | |

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|Infrastructure | |

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|Project Location & Description: ______________________________ | |

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|Cost: $       |

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|Non-Infrastructure |

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|Project Description:_____________________________________________ |

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|Cost: $______ |

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|Total Cost: $______ |

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|Please note that the Total Cost for all recommended work cannot exceed $150,000.00 |

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(Add additional sheets if necessary)

Section G

Line Item Budgets

Project Location for Infrastructure Activities:________________________

| |Quantity |Unit |Unit Price |Total Cost |

|Item | | | | |

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|TOTAL |  |  |  | |

Note: Construction engineering and inspection (CE&I) is an eligible expense and it should be included in your cost estimate.

Non-Infrastructure Activities

| |Quantity |Unit |Unit Price |Total Cost |

|Item | | | | |

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|TOTAL |  |  |  | |

TOTAL Cost:

Section G

Line Item Budgets

EXAMPLE

Sidewalks along 1st St., 3rd St. & Gray Avenue

| |Quantity |Unit |Unit Price |Total Cost |

|Item | | | | |

| Sidewalk |1,400 |Square Feet |$6.00 | $ 8,400.00 |

| Crosswalk Stripe |900 |Linear Feet |$0.39 | $ 351.00 |

| Curb Cuts for Handicapped Access |16 |Each |$400.00 | $ 6,400.00 |

| Speed Radar Feedback Device |1 |Each |$6,000.00 | $ 6,000.00 |

|(battery-pole) | | | | |

|Speed Radar Feedback Device (Solar) |1 |Each |$10,000.00 | $ 10,000.00 |

|Bicycle Rack |1 |Each |$1,200.00 | $ 1,200.00 |

|CE&I | | | | $ 4,853.00 |

|TOTAL |  |  |  | $ 37,204.00 |

Non-Infrastructure Activities

| |Quantity |Unit |Unit Price |Total Cost |

|Item | | | | |

|SRTS Bike Safety Rodeo |1 | |$500.00 | $ 500.00 |

|Walk-on-Wednesday Event |50 | |$3.75 | $ 187.50 |

|(Pedometers) | | | | |

|Bicycle Safety Instruction Booklet |200 | |$1.35 | $ 270.00 |

| Fact Sheet for Mayor/Community |200 |  |$0.35 | $ 70.00 |

|Crossing Guard Training Seminar |1 |Each |$3,000.00 |$3,000.00 |

|TOTAL |  |  |  |$4,027.50 |

TOTAL Cost: $41,231.50

NOTE: Do not include this example page in your application.

Section H

Scope of Work

A detailed statement (maximum two paragraphs) must be written for each element of work proposed (list below). A Scope of Work must be listed for all of the proposed work in the given application. The Scope of Work elements are as follows:

• Needs Assessment

• Eligibility Statement

• Project Source Documentation

• Line Item Budgets

• Planned Outcome(s)

• American with Disabilities Act

• Details of Non-Infrastructure Activities (International Walk to School Day activities, Traffic Bingo, Walking School Bus, Bicycle Rodeos, etc…)

• Maintenance Responsibilities

Attachments Reminder

When finalizing the application, please do not forget five (5) important sections that are required:

• Section C: Minutes of Organizational Meeting(s)

• Section D: Minutes of Public Meeting(s)

• Section I: Map or Drawing of the Project Area (limits of infrastructure project )

• Section J: Photographs Illustrating Conditions at the Site

• Section L: Letters of Support

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EXAMPLE

EXAMPLE

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