FY23 Appropriations Request

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Your Contact Information

Prefix:

First Name:

Last Name:

Requesting Organization Name :

Address

Address 2

City/Town

State

ZIP Code

Email:

Contact Phone Number:

Phone Number

Request

Brief description of Program Request:

One-Page detailed description

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Request Type:

Location

Same as entity?

Location of project if different from Entity applying

Subcommittee:

Project total cost:

Is there a local match:

If there is a local match, please elaborate on the amount and funding sources:

Have you requested with a another member of congress:

If yes, which member and district:

For Programmatic Requests

Subcommittee and Agency

Please Select a Committee

Please select an agency:

Agriculture

Commerce Justice Science

Defense

Energy and Water

Financial Services and General Government

Homeland Security

Interior and Environment

Labor HHS

Legislative Branch

Milcon VA

State and Foreign Operations

Transportation, Housing and Urban Development

Program Funding Level

Exact Language Request:

Justification for Language Request

Community support

Community engagement and support is crucial in determining which projects are worthy of Federal funding. Only projects with demonstrated community support will be considered.

Do you have any of the following? If answer yes please attach with the form

Letters of support from elected community leaders (e.g. mayors or other officials)

If yes please elaborate below:

Document Upload

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Press articles highlighting the need for the requested Community Project Funding

If yes please elaborate below:

Document Upload

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Support from newspaper editorial boards

If yes please elaborate below:

Document Upload

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Projects listed on State intended use plans, community development plans, or other publicly available planning documents

If yes please elaborate below:

Document Upload

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Resolutions passed by city councils or boards.

If yes please elaborate below:

Document Upload

One file only.
2 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Please provide a justification for why it is an appropriate use of taxpayer funds

Financial disclosure for community project funding

Do you or any of your associates have any personal connection to Rep. Beth Van Duyne and/or her family?

Will you or any of your associates personally benefit financially from the inclusion of the Community Project Funding?

Please select all that apply to the entity making the request

For Profit recipient

State, local or Tribal entity

Non-profit recipient

Lobbyist