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Conservation Fund Eligibility Form COMMUNITY 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: Conservation Commission Conservation Fund Project Sponsor/Organization: Northampton Conservation Commission Contact Name: Wayne Feiden, Director of Planning and Sustainability Property Owner, if applicable: N/A Mailing Address: 210 Main Street, Room 11, Northampton MA 01060 Daytime phone #: 413-587-1265 Fax #: 413-587-1264 E-mail address: wfeiden@northamptonma.gov CPA Program Area (check those that apply): X Open Space � Historic Preservation � Community Housing � Recreation Project Purpose (check those that apply): X Acquisition X Creation X Preservation � Support X Rehabilitation/Restoration Project Summary: Please provide a brief description of the project. CPA Funding is sought to contribute to the Commission’s Conservation Fund. Established under Mass General Law C40 §8C, the Fund is used for open space acquisition, creation, preservation, and restoration/rehabilitation projects consistent with the CPA, Northampton Community Preservation Plan, and Open Space, Recreation and Multi-Use Trail Plan. For CPC Use Eligible: _____ Not Eligible: _____ Date: __________ Reviewer: ____________________