Safe Routes Activating Communities Program Application Form

Community/Organization Information

1. Community Name

2. Agency Name

3a. What type of organization do you represent? Applicants must be a political subdivision of the state to be eligible for the Activating Communities pathway

Local or tribal government School Special district (e.g. school, parks and recreation, business improvement, etc.) Other

3b. If you selected "Other", please specify your organization

4a. Are you partnering with another organization for this program?

yes no

4b. If you selected "yes," please list the partner organization

5. What is your organization’s total approximate full time equivalent (FTE) staff?

6. Mailing Address Please include street address, city, state and ZIP code

Primary Contact Information

7a. First and last name

7b. Role in the community or agency

7c. E-Mail address

7d. Phone Number

Safe Routes Development

Below is the list of safe routes development stages:

Beginning stage - Haven’t started anything or have recently started researching where to begin
Research/Planning stage - Currently researching and/or developing a plan(s)
Program Deployment stage - Have a draft plan and have started working on a program or projects (including engagement or educational activities)

8. What stage is your organization at in developing its Safe Routes program?

Beginning stage Research/Planning stage Program Deployment stage

9. If relevant, tell us in 1 to 2 sentences what you have accomplished so far in developing safe routes for your community.

10. Tell us about your community and the people you serve Please include the demographics, income levels, whether you are primarily rural or a small town, and how your community’s resource levels impact your need for support.

Current Challenges

11a. What challenges is your community facing in getting more people to walk, bike and roll for transportation? Challenges examples: safety, lack of infrastructure, health, economic changes, etc.

11b. What everyday destinations are currently the most challenging or unsafe for residents to reach? Destination examples: schools, grocery stores or parks

Capacity & Commitment

This program will require regular participation. The Champion will attend the six community of practice sessions, participate in technical assistance one-on-one calls and be responsible for completing the Safe Routes Action Plan.

12a. Who will be the "Champion" staff member?

12b. Please describe your Champion’s connection to the community and previous work on similar projects.

The Vision

13a. How do you plan to use this Safe Routes Action Plan once it is finalized?

13b. How will it fit into your community’s long-term vision for walking, biking and rolling?

Kick-off Activity

14a. Tell us your idea for specific activity you want to try with the $10,000 mini-grant No need for a plan. If you don’t have an idea yet, that’s okay! You can skip this question

Acknowledgments

If an award is approved, this document represents your commitment to the following:

Attendance: I commit to attending all six virtual Community of Practice sessions. In the event that exigent circumstances prevent me from attending a session, I will make every reasonable effort to find a representative to attend in my place.
Action Planning: I commit to participating in up to 10 hours of 1-on-1 technical assistance with the Safe Routes Partnership to develop a Safe Routes Action Plan.
Mini-grant: I understand the $10,000 is a reimbursement grant for implementing an early action item identified and approved by CDOT during the planning process. The applicant organization will be responsible for paying for expenses up-front and submitting the required documentation to receive reimbursement. Each applicant awarded funds will receive a notice from CDOT to proceed prior to expending funds. These funds cannot be used for physical/infrastructure costs.
Deadline for Invoicing. I understand that the activity must be satisfactorily completed and invoiced for reimbursement by November 2027.
Reporting: I agree to submit a brief close-out/evaluation report to CDOT upon activity completion and prior to 12/31/2027[1.1].
Procurement: By completing and submitting this application, I acknowledge that if awarded, the use of grant awards will be in compliance with my entity’s procurement standards that identify appropriate procedures to ensure projects are procured through an open, equitable and competitive process.
Applicable Laws. By completing and submitting this application, I acknowledge the grantee’s President, Chief Elected Official (Mayor or County Commission Chair) or City/County Manager or equivalent, has certified they support this grant request to be submitted for funding and will follow all State fiscal policies, and state and federal regulations (including the Americans with Disability Act) for the entire activity, if awarded.

I understand that upon submitting this form, I acknowledge the statement above