Project Qualification Form - Cummins
Project Qualification Form - Cummins
Project Qualification Form - Cummins
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<strong>Project</strong> <strong>Qualification</strong> <strong>Form</strong><br />
As part of your grant request to the <strong>Cummins</strong> Foundation Architecture Program, we ask<br />
that you complete the form below to help us better understand your proposed project,<br />
and determine its fit within the guidelines and priorities of the Architecture Program.<br />
For any questions that require further detail or additional background, please attach a<br />
separate document with the necessary information.<br />
Grant Request Details<br />
Requestor:<br />
Date:<br />
<strong>Project</strong>:<br />
<strong>Project</strong> Manager:<br />
Funding Sources:<br />
Please attach a proposed<br />
project budget.<br />
Entity Receiving<br />
Architecture Program<br />
Funding, if approved:<br />
Owner of the facility<br />
(if different during<br />
construction and once<br />
occupied, please explain)<br />
Confidential <strong>Project</strong> <strong>Qualification</strong> <strong>Form</strong> Page | 1
Criteria<br />
Yes/No<br />
1<br />
What is the proposed function(s) of the building What group(s) will use the space and for what<br />
purposes<br />
2<br />
3<br />
4<br />
5<br />
Is this proposed project for a public building<br />
Is the proposed project located in Bartholomew County If so, please detail<br />
location.<br />
Does zoning allow the proposed uses and building on this land<br />
Please explain how you plan to pay for construction of the building.<br />
Yes<br />
No<br />
Yes<br />
No<br />
Yes<br />
No<br />
6<br />
7<br />
8<br />
Is this project a renovation or update to an existing building If so, please<br />
explain.<br />
Has the public engaged in this project Is there a possibility of a referendum<br />
or remonstrance If so, please explain.<br />
Has a long-term plan been developed for the building’s maintenance and<br />
funding If so, please attach.<br />
Yes<br />
No<br />
Yes<br />
No<br />
Yes<br />
No<br />
9<br />
10<br />
What is the estimated start and completion date for this project<br />
START DATE:<br />
COMPLETION DATE:<br />
What is the proposed building type (e.g. school, fire station, community center, etc.)<br />
What is the estimated total square footage and height of the building<br />
11<br />
Confidential <strong>Project</strong> <strong>Qualification</strong> <strong>Form</strong> Page | 2
Comments:<br />
Signatures for Submission<br />
Requestor: Date: / /<br />
<strong>Project</strong> Manager: Date: / /<br />
Funding<br />
Sources: Date: / /<br />
Date: / /<br />
Confidential <strong>Project</strong> <strong>Qualification</strong> <strong>Form</strong> Page | 3