This form is to help identify impacts to Delaware County from the pandemic and possible solutions to address those needs for ARPA Coronavirus State and Local Fiscal Recovery funds apportioned to Delaware County.

The American Rescue Plan Act (ARPA) of 2021 provides relief funds to state, local, and Tribal governments to enable them to continue to support the public health response and lay the foundation for a strong and equitable economic recovery. Delaware County recognizes that certain entities have faced pressures and impacts in responding to the public health emergency. Delaware County is requesting feedback from the community on the needs facing their areas of service due to the pandemic.

These funds are limited, one-time use monies and must comply with guidance from the U.S. Treasury. Not all requests will be eligible and not all requests will be funded.

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* 1. Contact Information Required

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* 2. Requesting Entity Type

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* 3. Requesting Entity's Purpose

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* 4. Which of the following does your proposed project promote?

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* 5. Briefly describe the reason funds are being requested. What harm does this request seek to address?

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* 6. How does this request address that harm and how would the funds support a strong and equitable recovery from the COVID-19 pandemic?

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* 7. Please provide any data to support this request and describe outcomes that will be monitored and measured from the use of these funds.

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* 8. Amount Requested and Proposed Budget (Whole Numbers Only)

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* 10. Provide a description of the amount of all federal loans, grants, or aid provided for COVID-19-related purchases including from the Coronavirus Aid, Relief and Economic Security (CARES) Act, Public Law 116-136, or other similarly purposed federal act for which the applicant has received.

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* 11. If your entity is a 501(c)(3), upload your IRS Determination Letter.

PDF, DOC, DOCX file types only.
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* 12. Upload your last 2 fiscal years of financial information [or Form 990 if your entity is a 501(c)(3)].

PDF, DOC, DOCX file types only.
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* 13. Supporting Documentation: upload any supporting documentation for answers to 1-8 above.

PDF, DOC, DOCX file types only.
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Thank you for completing this form. To finish this request after all questions are answered, please use the "DONE" button below. We will be in contact with a determination or a request for additional information.

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