Statewide Broadband Planning Assessment

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* 1. Contact & Community Information

Organization

Name

Phone

City/Town

Legislative District

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* 2. Broadband Project Information

Broadband Project Name (if known)

Project Manager/Consultant (If known)

Project Manager/Consultant Phone

Project Manager/Consultant Email

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* 3. Please indicate the status of your current broadband projects

Community Outreach/Feasibility Study

Network Planning

Ready for Construction

Other (please specify)

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* 4. Estimated Project Duration (in months)

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* 5. Estimate Total Project Cost

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* 6. Do you have a funding source for your project? If so, please describe?

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* 7. Have you created a community or broadband action team?

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* 8. If you have a community or broadband action team, describe the types of participating entities

Local/Gov't

Schools

Libraries

Tribes

Health Clinic/Hospitals

Public Safety

Emergency Management

Economic Developments

Local Internet service providers

Other (please specify)

Statewide Broadband Planning Assessment

Question Title

* 1. Contact & Community Information

Question Title

* 2. Broadband Project Information

Question Title

* 3. Please indicate the status of your current broadband projects

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* 4. Estimated Project Duration (in months)

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* 5. Estimate Total Project Cost

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* 6. Do you have a funding source for your project? If so, please describe?

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* 7. Have you created a community or broadband action team?

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* 8. If you have a community or broadband action team, describe the types of participating entities

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* 9. If you don't have a broadband action team, what is your plan for engaging community members in your broadband planning?

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* 10. Please describe the proposed broadband service area

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* 11. How many residences, businesses, farms, public safety agencies, hospitals, schools, and library service locations will be served by your plan?

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* 12. Outline any known policy and/or regulatory impediments to the expansion of broadband in the proposed service area:

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* 13. Describe any additional relevant factors that further motivate this project?

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* 14. Describe the economic benefits of the project and how those benefits will be measured?