Arc Form 3 - Non-Construction Project Application (Page 3 of 3) in pdf

ARC FORM 3 - Instructions

The ARC Form 3 is a standard form which must be completed by applicants requesting assistance from the Appalachian Regional

Commission for non-construction projects. Applicants must complete ARC Form 3 as follows:

Top Section

ARC Project Control Number: Leave blank. This number is assigned by ARC Washington office upon receipt of the

full application.

Number 1: Identification

Project Name: Please use the same title for the project that you listed on the Federal 424 form.

Location: Identify only the largest political subdivisions affected.

State: Identify the state in which the project will take place.

Number 2: ARC Goal Area

Check the appropriate box, identifying the ARC Goal under which the project should receive funding consideration.

Number 3: Type of Project

Check the appropriate box identifying the project type.

Number 4: Budget Period

Identify the starting and ending dates of the Project. Be sure to include the applicable year(s).

Number 5: Cost Request

Operations/TA column: If part or all the project is for operations, training or technical assistance (see #3 above),

identify the dollar amount and percentage of the total cost which will be provided by each source listed in the far left

column (ARC funds, Other Federal Funds, State Funds, Other Funds) for the operations/TA part of the project.

Equipment column: If part or all of the project is for the purchase of equipment, identify the dollar amount and

percentage of the total cost which will be provided by each source listed in the far left column for the purchase of this

equipment.

Total column: In this column, identify the total dollar amount and percentage of the total cost which will be provided

by each source listed in the far left column.

Total Cost row: Identify the totals and percentages for the operations/TA column, the equipment column, and the

total column.

Specify source(s) of other federal funds and Approval Date: If other federal funds have been secured for this project,

provide the source and approval date of these funds.

Signature, Date, Typed Name & Title

Applicants need to provide the following:

Signature of Responsible Officer and Date: The signature of an authorized representative of the applicant

organization should be provided, and the date the document was signed by this person should be identified.

Name and Title of Responsible Officer: Provide the typed name and title of the authorized representative who is

signing this section.

Number 8: State Approval

Leave blank. This will be completed by the appropriate state ARC office.

ARC Form 3, page 2

Revised 2005

Arc Form 3 - Non-Construction Project Application Page 3