CPA-Eligibility-FillableForm.pdfForms
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-A – Allowable Use Table in the Community Preservation Planwhen 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 and Address, if applicable:
Mailing Address:
Daytime phone #: Fax #:
E-mail address & Website:
CPA Program Area (check those that apply):
c Open Space c Historic Preservation c Community Housing c Recreation
Project Purpose (check those that apply):
c Acquisition c Creation c Preservation c Support c Rehabilitation/Restoration
Project Summary: Please provide a brief description of the project.
For CPC Use Eligible: _____ Not Eligible: _____ Date: _________
Reviewer: _______________________________________________