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HomeMy WebLinkAboutIowa Department of Transportation-2/18/2013(Dlowa Department of Transportation Forrn 231024 (01-2013) Iowa Safe Routes to School Noninfrastructure Activities Grant Application (not for a SRTS Study or Plan) APPLICATION INSTRUCTIONS AND CHECKLIST This application is designed to help us learn as much as possible about your project. Your answers to the grant application questions are very important in helping us select the best projects. If some of the requested information is not provided, your project will not score well. Please be complete, but also concise. Limit your answers to no more than six pages in total. If you are applying for funding to complete a Safe Routes to School Study or Plan, use Form 231027. Important Dates March 1 Completed applications received by the Iowa DOT Office of Systems Planning by 4:30 pm June Projects anticipated to be selected for funding by the Iowa Transportation Commission Application Checklist ❑ Contact Information Sheet is completed and signed © Minority Impact Statement is completed and signed O Questions are answered on the form and in the format provided ❑ Answers are brief, but clear ❑ The Cost Estimate is complete ❑ All appropriate documents are attached (i.e., maps, letters of agreement, etc.) ❑ Completed application (eight copies) will be delivered by 4:30 pm on March 1 to: Kathy Ridnour Safe Routes to School Program Coordinator Iowa Department of Transportation Office of Systems Planning 800 Lincoln Way Ames, IA 50010 If you have any questions, contact Kathy Ridnour at kathy.ridnour@dot.iowa.gov or at 515-239-1713. Do not send this page with your completed application. 0lowa Department of Transportation Form 231024 (1-2013) Iowa Safe Routes to School Noninfrastructure Activities Grant Application (not for a SRTS Study or Plan) CONTACT INFORMATION SHEET Complete the information below and include this page as the first page of your application. The person identified as the Contact will be the main point of contact for Iowa DOT staff. © Organization School ❑ District ❑ City x! County State ❑ Other ❑ (check one) Project Title: Safe Routes To School Children Safety Awareness Activity Booklet Contact Name: Sandie Greco Contact Title: Traffic Operations Superintendent Organization: City of Waterloo Mailing Address: 408 E. 6th Street City, State, Zip: Waterloo, Iowa 50703 Best Phone # to Call: (319) 291-4440 Contact E-mail: sandie.greco@waterloo-ia.org Contact Fax: (319) 291-4094 Amount of SRTS Funding Requested: School District: Waterloo, Cedar Falls & more School Name: All Grade Schools Brief Description of Your Project and Location: (one or two lines only) Develop and distribute a series of Safe Routes to School safety awareness activity booklet and material for grade school children to area schools and a limited number of schools state-wide. The award of Safe Routes to School funds; any subsequent funding or letting of contracts for design, construction, reconstruction, improvement or maintenance; and the fumishing of materials for this project shall not involve direct or indirect interest of any state, county or city official, elective or appointive. All of the above are prohibited by Iowa Code Sections 314.2, 362.5 or 331.342. Any award of funding or any letting of a contract in violation of the foregoing provisions shall invalidate the award of Safe Routes to School funding and authorize a complete recovery of any funds previously disbursed. Certification To the best of my knowledge and belief, all information included in this application is true and accurate, including the commitment of all physical and financial resources. This application has been duly authorized by the applicant. I understand the following OFFICIAL ENDORSEMENT binds the applicant to assume responsibility for adequate maintenance of any new or improved facilities. I understand that, although this information is sufficient to secure a commitment of funds, an executed contract between the applicant and the Department is required prior to authorization of funds. Representing the City of Waterloo Signature A3/43 Date Typed Name and Title Date 1 IA Iowa Department of Transportation Form 105101 (02-11) MINORITY IMPACT STATEMENT Pursuant to 2008 Iowa Acts, HF 2393, Iowa Code Section 8.11, all grant applications submitted to the state of Iowa that are due beginning January 1, 2009 shall include a Minority Impact Statement. This is the state's mechanism for requiring grant applicants to consider the potential impact of the grant project's proposed programs or policies on minority groups. Please choose the statement(s) that pertains to this grant application. Complete all the information requested for the chosen statement(s). Submit additional pages as necessary. ❑ The proposed grant project programs or policies could have a disproportionate or unique positive impact on minority persons. Describe the positive impact expected from this project. Indicate which group is impacted: 0 Women 0 Persons with a disability ❑ Blacks 0 Latinos ❑ Asians 0 Pacific Islanders 0 American Indians 0 Alaskan Native Americans 0 Other 0 The proposed grant project programs or policies could have a disproportionate or unique negative impact on minority persons. Describe the negative impact expected from this project. Present the rationale for the existence of the proposed program or policy. Provide evidence of consultation with representatives of the minority groups impacted. 2 Indicate which group is impacted: ❑ Women ❑ Persons with a disability ❑ Blacks ❑ Latinos ❑ Asians 0 Pacific Islanders ❑ American Indians ❑ Alaskan Native Americans ❑ Other ® The proposed grant project programs or policies are not expected to have a disproportionate or unique impact on minority persons. Present the rationale for determining no impact. It will equally cover all minority and non -minority students attending schools. I hereby certify that the information on this form is complete and accurate, to the best of my knowledge: Signature: Title: Mayor g&I 3 Iowa Safe Routes to School Grant Application Safe Routes to School Activity Booklets For Grade School Children 1. A detailed study scope that clearly outlines your proposal, the need for the activities, and the types of activities to be carried out. Develop a set of Safe Routes to School children activity booklets for free distribution to area schools as well as a limited number of schools state-wide. Grade school children will be the target audience. Three sets of booklets are proposed. The first one will be about safe walking habits. Children will learn about safe walking habits as they color the booklet and engage in the activities and puzzles. Second series will be on safe biking. The third booklet will emphasize fun group activities for walking and biking to school. 2. A description of how the students will benefit from the proposed activities. Many of the goals of safe Routes to School program can be only fully realized when there is a cultural change resulting in behavioral and habitual changes. Younger children are at the best age for this purpose. Impression made on them will have a life-long lasting effect. 3. A description of the partnerships and collaborations that have been developed with organizations important to the success of your proposal. A copy of a traffic safety awareness activity booklet for children by Drive Safe Cedar Valley program (www.drivesafecv.org) is enclosed. It is approved by Waterloo School District. Cell phone use is tackled for the first time in such a booklet. As part of Drive Safe Cedar Valley program we have gained experience working with artists and others to make this proposal a successful one. 4. A discussion of how the success of your proposal will be measured. We will send post -distribution survey questions to schools and compile and analyze their feedback.. Effectiveness of programs aiming at long term cultural changes is hard to measure. 4 5. A detailed cost estimate ACTIVITY COST ($) QUANTITY TOTAL CREATIVE COMPONENTS 3,000 3 9,000 DRAWINGS 4,000 3 12,000 AGENCY PROJECT MANAGEMENT 2,000 3 6,000 PRINT 8,000 3 24,000 DISTRIBUTION 500 3 1,500 SCHOOL SURVEY 3,000 1 3,000 TOTAL 55,500 6. Information about the school(s) or district(s) that will be impacted by your proposal, including the name(s) of the school(s), grades of students at the school(s), and total number of K-8 students at the school(s). (Note: This information is not applicable to statewide projects.) Waterloo school district as well as area school districts will be affected. There will be extra copies for limited state-wide distribution. 5