SRD Supplemental Form.pdf

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v1.1 Applicant and Proposal Profile form - FY 2018 & FY 2019 Safety Research and Demonstration (SRD) Program Page of Applicant and Proposal Profile FY 2018 Safety Research and Demonstration (SRD) Program Is this a resubmission?

Has this proposal been submitted for any other DOT competitive grant program in the last 12 months?

Section I. Applicant Information Organization Type:

Project Location:

Please provide a description of transportation service and geographical areas served by the lead provider of public transportation:

Section II. Project Summary Summary:

Applicants may attach materials and documentation that supports the proposal submission, including graphics, maps, letters of support and any other documents, as appropriate. Applicants are encouraged to clearly reference any relevant attachment in the supplemental form.

List all supporting materials and documents included with proposal:

Which topic are you applying for Which topic are you applying for:

Rail Safety Hazard(s) Identified Provide Safety Data & Description of the issue(s):

Safety Improvements and Mitigation Strategies Proposed:

Extent/evidence that demonstration builds off of prior research, innovation, and development efforts:

Project Objectives:

Describe how the proposed project supports one or more FTA safety goals and FY 2018 SRD program objectives.

Exemptions/waivers:

Please indicate if any of these exemptions or waivers are required to implement the project, and impacts to the project if waivers are not granted.

Data Collection Management and Accessibility:

Describe the expected approach to data collection, data management and data access by the FTA and independent evaluators.

Section III. Evaluation Criteria Address each of the evaluation criteria as described in the notice of funding opportunity.

Project Innovation and Impact:

Project Approach:

National Applicability:

Commercialization and/or Knowledge Transfer:

Return on Investment:

Describe expected outcomes, benefits and impacts.

Project Timeline Timeline Item Description Timeline Item Date Team Capacity & Commitment, Partnerships Please provide the following information concerning each partner organizations:

Description of partners involved in project, their roles, capacities, and anticipated contributions:

Describe financial commitments of partners:

Letters of commitment attached?

Technical/legal/financial capacity of applicant (e.g., extent to which the team can successfully implement the proposed project, including the qualifications and experience of the team, past program management performance, and commitment to the project objectives):

Project Budget Total Cost ($) Other Federal Cost Share, if applicable ($) Other Federal Amount, if applicable ($) SRD Cost Share ($) SRD Federal Amount ($) Item Description

QTY

Total:

Matching Funds Information min 20% required Evidence of local match attached?

Project Scalability Is Project scope scalable?

Congressional Districts (Place of Performance) Congressional District Additional Information Opportunity zone?

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