General information--
Please provide us with information about yourself and your organization. |
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| Fed Tax ID Number:* |
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| Organization (Legal Name):* |
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| If applying on behalf of a region, please list the Region Name: |
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| Applicant Name:* |
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| Title: |
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| Address 1:* |
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| Address 2: |
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| City:* |
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| State:* |
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| ZIP:* |
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| Phone:* |
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| Fax: |
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| E-mail:* |
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| Select your Economic and Community Development Manager:* |
| Beth Brockette |
| Bruce Kepner, CEcD |
| Cindy Lenz |
| Keith Sherman |
| John Ziegenbusch |
| I don't know |
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| Eligibility-- |
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All information for our area is completed in LOIS for the Printable Brochure
including at least one photo per building, site and community profile:* |
| Yes |
| No |
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An active link to www.midwestsites.com
appears on our organization's Web site:* |
| Yes |
| No |
| Web site address: |
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Are you submitting more than one
Partnership Program application for this cycle?:* |
| Yes |
| No |
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Please select a priority option
for this application:* |
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Select the program you are applying for--
If you are applying for more than one program, please use a separate application form for each. |
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| Community Development |
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| Retention Marketing and Recruitment: |
| Industrial Marketing Support |
| Impact Analysis |
| Regional Partnership Support |
| Business Retention and Expansion |
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| Building and Site Development: |
| Spec Building Interest Buy-Down Financing |
| Shovel-Ready Site Development |
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| Workforce Development |
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| Innovation and Growth |
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| Professional Scholarship |
| List the name of the professional to receive the scholarship: |
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| Financial information-- |
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| Total estimated project cost:* |
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| Do you have state, local, or other matching sources? |
| Yes |
| No |
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| Please disclose all other sources of funding, either local or other match. |
| Source 1: |
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| Amount: |
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| Source 2: |
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| Amount: |
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| Source 3: |
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| Amount: |
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| Source 4: |
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| Amount: |
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| Source 5: |
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| Amount: |
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| Total amount requested from Alliant Energy:* |
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| Please note: the Total Amount awarded may be based on the number of communities served and type of service provided. This will be determined by Alliant Energy staff. |
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| General project information -- |
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| General project description:* |
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| What specifically will the funds be used for? |
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| Expected project time frame: |
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| Expected results: |
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| Follow-up plan: |
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