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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