PROJECT NOMINATION FORM

Directions: Copy and paste the numbered items into your favorite editor to complete the form. Please use additional sheets if necessary.

1. PROJECT NAME:

2. PROJECT LOCATION:

3. PROJECT SPONSOR:

4. PROJECT CONTACT INFORMATION (Example: Project Manager, Project Director):

5. PROJECT DESCRIPTION:

5a. TYPE OF PROPOSED PROJECT:

5b. PURPOSE AND NEED:

5c. STAGE OF THE NEPA PROCESS:

6. FEDERAL AGENCIES INVOLVED IN PROPOSED PROJECT DEVELOPMENT:

7. FEDERAL REVIEW ACTIONS REQUIRED:

8. EXISTING OR ANTICIPATED CONTROVERSIES WITH ENVIRONMENTAL OR OTHER REVIEW ISSUES:

9. SUPPORT OF LOCAL AND STATE GOVERNMENT AND TRANSPORTATION AGENCIES:

10. REASON PROPOSED PROJECT IS BEING NOMINATED INCLUDING NATIONAL AND/OR REGIONAL IMPORTANCE:

11. PROJECT NOMINATOR AND CONTACT INFORMATION:

Please send completed nomination forms to:

Nominations must be received on or before December 15, 2003. As regular mail may be delayed, we encourage submission by fax or Email.