AOM Eligibility FormCOMMUNITY PRESERVATION ELIGIBILITY
DETERMINATION FORM
The purpose of this form is to make sure that all project applications applying for Community
Preservation Act funding are eligible for funding. Please refer to Appendix-E in the
Community Preservation Plan when filling out this form. This form must be approved in
order for an application to be accepted.
Project Title:
Project Sponsor/Organization:
Contact Name:
Property Owner, if applicable:
Mailing Address:
Daytime phone #: Fax #:
E-mail address:
CPA Program Area (check those that apply):
Open Space Historic Preservation Community Housing Recreation
Project Purpose (check those that apply):
Acquisition Creation Preservation
Support Rehabilitation/Restoration
Project Summary: Please provide a brief description of the project.
For CPC Use Eligible: _____ Not Eligible: _____ Date: __________ Reviewer: ____________________