OPP 2165

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					                                                                                Notification of Intent to Apply for
                                                                                Economic Development Funds


Name of Local Government to Sponsor the Project:

Address:




Contact Person:                                                           Phone Number:

Firm Name:

Type of Product:

Tourism Event:
  (if applicable)

Annual Attendance:                                             Peak Day Attendance:

Is there a letter of commitment for this industry to expand or locate:                Yes (if yes, please attach)            No

Number of Jobs Retained:                                         Anticipated Opening Date:

Number of New Jobs:

Description/Scope of the Project (Please include project limits):




Estimated Cost of Transportation Improvements:             $

Amount of Local Matching Funds:           $

List attachments to this application (i.e. cost estimate breakdown, maps, commitment letter, etc.)

1)
2)
3)
4)


Please send this completed application form and any attachments to:

          Chief, Bureau of Statewide Program Planning
          Room 307
          Illinois Department of Transportation
          Springfield, Illinois 62764
For further information on the Economic Development Program go to IDOT’s web site
http://www.dot.state.il.us/edp.html or call (217) 782-2755.

Note: This application form is being utilized as an initial notification for your project. IDOT will require
additional information before Economic Development Program funds can be committed.


Printed 2/18/2012                                                                                               OPP 2165 (02/23/09)

				
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