The file's text, extracted by GovTribe without its formatting.
Site Worksheet
| Site Worksheet |
| (Insert additional rows as needed) |
| Site Number | Site Name | Site Designation (Hub; Hub/End-User; | | | |
| End-User) | Street Address | Town | County | State | 5 Digit ZIP | Congressional District |
Rurality Worksheet
| Rurality Worksheet | | |
| (insert additional rows as needed) | | |
| Minimum Score of 20 points required for eligibility | | |
| Site Number | Site Name | Site Designation |
(Hub; Hub/End-User;
| End-User) | Town or Place Name | Census Population | Is Site in a Town adjacent to City or Town > 50,000? | Name of Adjacent Urban City or Town (if Yes in prev. col. ) | Rurality Score | |
| | | | | | Yes |
| | | | | | No |
| Applicant's Estimated Rurality Score |
| (Sum of Rurality Points / # of End-User Sites) |
| Scoring Table | |
| Census Population | Points |
| EXCEPTIONALLY RURAL AREA - 5,000 or less | 40 |
| RURAL AREA - 5,001-10,000 | 30 |
| MID-RURAL AREA - 10,001-20,000 | 20 |
| URBAN AREA - Over 20,000 or Adjacent to City > 50,000 | 0 |
NOTE: Enter the hub and end user sites in the same order as shown on the Site Worksheet. Enter the population associated with each hub and end user site. Do not score or include hub sites in the final calculation of the Rurality score. The hub information is required should RUS determine that a hub site is actually an end user site or combination hub/end user site where it would be scored. See section C1 – Rurality of Application Guide for additional instructions.
Matching Worksheet
| Matching Worksheet |
| (insert additional rows as needed) |
| Donor | Proposed Match ($) |
| (must provide Documentation Letter from each donor) | |
| 1. Total Proposed Matching Contribution (must equal Line B + Line C in the Budget Worksheet) | $ - 0 |
| 2. Total DLT Grant Request (Must equal Line D in the Budget Worksheet) | $ - 0 |
| Match Percent (Line 1 ÷ Line 2), must be at least 15% of Grant Request | |
Budget Worksheet
| Budget Worksheet |
| (Insert additional rows as needed) |
| Items being funded by Grant and Cash Match | | | | | |
| Line Item # | Site Number & Name | Description | Unit Cost | # of Units | Extended Cost |
| 1 | | | | | $ - 0 |
| 2 | | | | | $ - 0 |
| 3 | | | | | $ - 0 |
| 4 | | | | | $ - 0 |
| 5 | | | | | $ - 0 |
| 6 | | | | | $ - 0 |
| 7 | | | | | $ - 0 |
| 8 | | | | | $ - 0 |
| 9 | | | | | $ - 0 |
| 10 | | | | | $ - 0 |
| 11 | | | | | $ - 0 |
| 12 | | | | | $ - 0 |
| 13 | | | | | $ - 0 |
| 14 | | | | | $ - 0 |
| 15 | | | | | $ - 0 |
| 16 | | | | | $ - 0 |
| 17 | | | | | $ - 0 |
| 18 | | | | | $ - 0 |
| 19 | | | | | $ - 0 |
| 20 | | | | | $ - 0 |
| 21 | | | | | $ - 0 |
| | Total Grant and Cash Match | | | $ - 0 |
| Items being contributed as In-Kind Match (if applicable) | | | | | |
| Line Item # | Site Number & Name | Description | Unit Cost | # of Units | Extended Cost |
| 1 | | | | | $ - 0 |
| 2 | | | | | $ - 0 |
| 3 | | | | | $ - 0 |
| 4 | | | | | $ - 0 |
| 5 | | | | | $ - 0 |
| 6 | | | | | $ - 0 |
| 7 | | | | | $ - 0 |
| 8 | | | | | $ - 0 |
| 9 | | | | | $ - 0 |
| 10 | | | | | $ - 0 |
| | Total In-Kind Match | | | $ - 0 |
| A | Overall DLT Project Budget (Sum of Total Grant & Cash Match and Total In-Kind Match) | | | | $ - 0 |
| B | Less Proposed Cash Match (as documented on Matching Worksheet) | | | | $ - 0 |
| C | Less In-Kind Match | | | | $ - 0 |
| D | DLT Grant Request (A-B-C) | | | | $ - 0 |
| | | | Grant to Match % check (15% minimum req'd) | |
