2020 Transportation Growth Management Grant ApplicationInstructionsBe sure to download and review the 2020 application packet before filling out this grant application.

The application packet, additional resources, and examples of successful applications can be found on the TGM planning grants page.

You can save your progress and revisit this form at any time by clicking the "Save" button at the bottom of each page.

Applications must be received by July 31, 2020 at 11:59 p.m. (PDT)

Applicant informationInstructions: Complete this information for the applicant. Provide both a designated contact and an authorized representative (if different than the designated contact) for your entity. The authorized representative is someone who is authorized to make decisions and sign a funding agreement with ODOT should your project be chosen for funding.

Primary applicant jurisdictionCity of Florence

Mailing address250 Highway 101, Florence, Oregon 97439

Websitehttps://ci.florence.or.us

Contact person nameWendy Farley-Campbell

Contact person titlePlanning Director

Contact phone(541) 997-8237

Contact emailWendy.FarleyCampbell@ci.florence.or.us

Would you like to receive TGM news and updates?I am already subscribed

Authorized representative name, if different from the applicant contact

Megan Messmer

Authorized representative titleAIC City Manager

Phone(541) 997-3437

EmailMegan.Messmer@ci.florence.or.us

List other participating local jurisdictions (if any)List other participating local jurisdictions (if any)Participating local jurisdiction Providing match?

Project name and locationProject titleCity of Florence TSP Update

Project area: Using either of the two fields below, attach a map of the project area or describe the area your project is located in.

Option 1: Project area map Option 2: Project area descriptionFlorence Urban Growth Boundary

ODOT region (1-5)Region 2

ODOT Region Map

Type of grantCategory 1: Transportation System Planning

Summary description of projectThe City of Florence is applying for technical assistance to update their Transportation System Plan. The current plan was adopted in 2012 and is no longer working due to growth and changes in the City. When the current TSP was adopted, the City was not in a place financially to make some of the longer-range planning decisions needed, therefore many important projects were not included, resulting in a weak TSP. Additionally, many of the larger projects that were identified in the current TSP have been completed. The expected outcomes would be a City Council adopted TSP with a more reader-friendly approach, with simple chapter categories and graphic representations. The TSP would have a focus on creating a multi-modal plan, not just focused on cars, but on creating a connected, equitable, and walkable community for not only our residents, but our visitors as well.

Project cost tableTGM funds requested

Consultant$150,000.00

Local reimbursement

Total TGM funds requested$150,000.00

Local match 12% minimum (calculated)$20,454.55

Match to be provided

Labor, supplies and services during project$2,454.55

Payment when Intergovernmental Agreement is signed$18,000.00

CertificationsCertificationsThis application was prepared by staff of the primary applicant or staff of one of the involved jurisdictions

Certifications checkboxBy checking this box, I certify that my organization listed above supports the proposed project, has the legal authority to pledge matching funds, and has the legal authority to apply for Transportation and Growth Management funds. I further certify that matching funds are available or will be available for the proposed project.

Eligibility requirements

Applications are reviewed on a pass/fail basis on each of the following three requirements.

Applications found to not meet each of these requirements will not be scored against the award criteria and will not be awarded a grant.

1. Clear transportation relationship

A proposed project must have a clear transportation relationship and produce transportation benefits. A project must entail analysis, evaluation and selection of alternatives, development of implementation actions, and public involvement that results in a long range transportation plan, land use plan, or other product that addresses a transportation problem, need, opportunity, or issue of local or regional importance.

Certification: Clear transportation relationshipBy checking this box, I certify that the project meets this eligibility criterion.

2. Adoption of products to meet project objectives

A proposed project must include preparation of an adoption-ready product or products that lead to a local policy decision and that directly address the project objectives, such as a transportation system plan, comprehensive plan amendment, land use plan, code amendment, implementation program, or intergovernmental agreement. Projects are expected to include adoption hearings (or equivalent) by the governing body or to prepare products which will be adopted as part of a larger project.

Certification: Adoption of products to meet project objectivesBy checking this box, I certify that the project meets this eligibility criterion.

3. Support of local officials

A proposed project must clearly demonstrate that local officials, both the primary applicant and any co-applicants, understand the purpose of the grant application and support the project objectives. A resolution of support, meeting minutes, or authorized letter from the governing body of all applicants (e.g. City Council, Board of Commissioners, or Transit Board) must be submitted with the application to meet this requirement.

Upload your resolution, minutes or authorized letter from governing body of applying jurisdiction(s) here:Resolution 10 Series 2020 - Signed.pdf

Award criteria

Criterion 1: Proposed project addresses a need and supports TGM objectives (up to 40 points)

The project clearly and effectively addresses a local or regional transportation or transportation-related land use issue, problem, need, or opportunity and will achieve one or more of the TGM objectives.

Application instructions and example responses can be found here.

Explain how your proposed project addresses a need and supports TGM objectivesAn updated Transportation System Plan will achieve three of the TGM objectives; Provide transportation choices to support communities…, Create communities composed of vibrant neighborhoods…, and support economic vitality and growth….

Provide transportation choices: The City of Florence is committed to continuing to provide and expand the transportation choices that are available to its residents and visitors, including investing in the current public transportation system, and ideally expanding the system. In coordination with Lane Council of Governments (LCOG), Lane Transit District (LTD) and soon, Coos County Area Transit (CCAT), the City of

Florence will be a hub for three different regional bus lines, Florence to Eugene, Florence to Yachats, and Florence to Coos Bay. These lines continue to serve our most vulnerable populations with options on how to move around the region while also living in an isolated community like Florence. Our local bus route, the Rhody Express, has also seen a growth in customers over the last few years, with over half of the riders being either elderly or disabled. To continue to support our public transit system, the City of Florence needs a centrally located transit hub, which would provide a place for all four bus routes to stop, pick up and drop off passengers, and allow for riders to feel safe while waiting for the bus. Investing in a safe and welcoming transit hub for our City’s local and regional transit system would help reduce reliance on roadways for auto travel.

Create communities composed of vibrant neighborhoods: The City of Florence’s pedestrian and bike infrastructure is lacking connectivity. The gaps in the sidewalk network and the piecemeal development of the City’s bicycle facilities has resulted in a lack of connectivity and the continued automobile reliance on US 101. Since the City updated their TSP in 2012, Florence has participated in the Safe Routes to School program, as well as redeveloped a section of Rhododendron Drive, installing sidewalks, larger margins, and bike lanes, with plans in the engineering phase to continue to redevelop the remaining portion of Rhododendron Drive. Additionally, the City has recently completed a major overhaul of Highway 126 and Highway 101, in coordination with ODOT, to expand sidewalks, create plazas and raised medians, and install bike lanes. When the City updates their TSP, alternate modes of transportation will be given a stronger voice to help reduce this reliance on auto travel and create more vibrant Florence neighborhoods.

Support Economic Growth and Vitality: The City of Florence hosts over 750,000 visitors a year, due to our proximity to the Pacific Ocean and the Oregon sand dunes. The tourism and hospitality industry is the largest industry sector in the City. The Transportation System Plan must acknowledge and support growth in this industry. An updated TSP would evaluate new growth and tourism rate forecasts for Florence to allow transit take on a larger role in Florence’s transportation system in the future. In addition, an updated TSP would allow the City of Florence to consider an evaluation of the parking in Old Town (the tourism hub of the City), looking for parking management solutions to meet parking needs, especially with the planned expansion of the Florence Events Center and the Urban Renewal Agency’s desire for a hotel and ancillary businesses across the street. Improved and connected pedestrian and bicycle infrastructure will be required to support Florence as a tourist destination. Additionally, the City has made significant investments in time and money to support the development of “missing middle” housing options. In 2019, the City of Florence did a major overhaul of their housing codes to spur development, the first time that significant work has been done on them in over 30 years. In the new codes, the City reduced parking minimums to allow for more housing options to be built on properties. In order for these changes to be successful, the City needs to work with developers to expand the sidewalk system and bicycle infrastructure.

Criterion 2: Proposed project is timely and urgent (up to 25 points)

The application demonstrates timeliness and urgency. The project is needed now to:

address pressing local transportation and land use issues

make amendments to local plans or regulations necessitated by changes in federal regulations, state requirements or regional plans

make amendments to local plans or regulations necessitated by changes that were not anticipated in previous plans, including growth or lack of growth, changes in land-use patterns or changes in available funding

build on, complement or take a necessary step toward completing or implementing other high priority community initiatives, including Governor's Regional Solutions Team priority

resolve transportation or land use-related issues affecting the project readiness of local, regional or state transportation projects for which funding is expected to be obligated within the near future

Application instructions and example responses can be found here.

Explain how your proposed project is timely and urgentAn update to the Transportation System Plan for the City of Florence is timely and urgent due to a few factors; out of date data, significant growth, the need for updated emergency evacuation plans, and the need to reevaluate the City’s project list.

Out of Date Data: The data used to analyze the then current situation and future project infrastructure needs is desperately out of date. Development has and is starting to occur in already congested locations where LOS thresholds will be met ahead of projections and no pedestrian or transit infrastructure is proposed. The data needs updating to reflect the number of cars that travel through and around Florence and identify infrastructure needs. The development requirements were completed during the height of the 2008 recession which does not reflect the increase in tourism and development that has occurred since then.

Significant Growth: The City has experienced significant growth over the last eight years. City Staff estimate that the City has processed more annexations since 2012 than in the 20 years before it combined. The 2018 Economic Opportunities Analysis report shows that since the year 2000, the population in the City of Florence has increased by over 19% and is projected to grow 18% between now and 2040. The City’s Transportation System Plan needs to reflect this growth and plan for the City’s future.

Emergency Evacuation Plans: Because of Florence’s proximity to the Ocean, planning is necessary to mitigate the threat of a tsunami in the City’s inundation areas. In 2018, the City participated in the Tsunami Pedestrian Evacuation Analysis Mapping project and made changes to our comprehensive plan and code based on the results. The TSP needs to be updated to reflect the most current evacuation plans and policies. Additionally, Florence currently has several routes leading north-south within the inundation area, but few that lead east-west to facilitate quick and efficient evacuation. A TSP update would identify routes that lead away from the induction zones, including pedestrian and bicycle paths that could provide additional mobility in a natural disaster.

Reevaluation of City’s Project List: The project list in the current TSP has had some of the major projects completed, including the improvements done to Highway 101, Highway 126, and Rhododendron Drive. However, many of the necessary projects were not included in the final, adopted TSP project list due to a hesitant City Council and the City’s shaky financial outlook due to the Great Recession. In addition, population growth has accelerated the need for additional improvements beyond those envisioned in the current TSP. A new 20-year list of improvement projects and a financing plan for implementing those projects is needed.

In the Spring of 2020, the City of Florence completed a TGM TSP Assessment. The assessment reaffirmed these four factors, but also reiterated the importance of updated pedestrian and bicycle systems to make Florence a more active community and reduce reliance on auto trips within and outside Florence.

Criterion 3: Proposed project approach is reasonable (up to 20 points)

The application demonstrates a clear approach to achieving the expected outcome and includes consideration for adoption. Where substantial coordination with other local, regional, and state planning efforts will need to occur, the mechanisms and responsibilities for the coordination are clear.

Application instructions and example responses can be found here.

Explain how your proposed project approach is reasonableBy identifying an array of transportation elements needing to be addressed in the recent TSP Assessment, the City was better informed on exactly what to focus on in our TSP update. It was immediately apparent that an entirely new document was necessary. The TSP Assessment team highlighted the importance of Florence as a regional transit hub as well as the gaps in the existing pedestrian and bicycle network. The TSP Assessment stressed the importance of realigning the TSP with state, regional and local plans, and policies (such as ADA provisions) that were put in place after the current TSP was adopted, and recommended a rewrite of the TSP in a more inclusive and reader-friendly format. The City plans to follow the process outlined in the ODOT Transportation System Plan Guidelines.

In early 2019, the Florence City Council created a Transportation Committee who has been meeting on a regular basis since February 2019. The committee of ten volunteers and five ex-officio members represent various transportation and mobility interests. They will be working with staff to collect community input and host open houses on the Transportation System Plan update. This involvement will happen similarly to how the City’s Community & Economic Development Committee (CEDC) was involved in the updates to the residential building codes in 2019. The CEDC created a subcommittee with members of the City Council, Planning Commission, Committee members and interested stakeholders. The subcommittee worked diligently to understand, modernize, and eventually advocate for the adoption of the codes. The City of Florence intends to use a similar format to update the TSP.

The primary deliverable will be the new TSP that incorporates existing related city, regional and state policies and plan language that guides area transportation investments. The expected project completion is approximately 12 months once a consultant team has been contracted. This timeline will require coordination between the City, the Consulting team, regional agencies, and the public. The public will be involved in reviewing drafts and in garnering suggestions through surveys and evaluations as the draft moves forward to completion. The Consulting team will be responsible, in concert with the City, with public involvement processes regarding the TSP draft and providing ways to evaluate the TSP, identify which entity or department is responsible for recommended actions within the TSP.

Criterion 4: Proposed project has community support (up to 5 points)

The application demonstrates that there is local support for project objectives, a commitment to participate, and a desire to implement the expected outcome.

Application instructions and example responses can be found here.

Upload letters of support from stakeholders hereTravel Lane County LOS.pdf

CTCLUSI LOS.pdf

Lane Transit District LOS.pdf

Peace Harbor LOS.pdf

Siuslaw School District LOS.pdf

Criterion 5: Proposed project sponsor readiness and capacity (up to 10 points)

The application demonstrates that the local government is ready and able to begin the project within the

TGM timetable and that there is local commitment and capability to manage and complete the project. The application demonstrates, if applicable, successful performance on previous TGM projects.

Application instructions and example responses can be found here.

Explain how proposed project sponsor is ready and capableThe City of Florence is ready to begin the project within the TGM timetable. The Florence City Council has committed to support the update of the TSP both by including the item in their 2019/2020 Work Plan and by issuing the attached Resolution of Support. Additionally, The City has designated specific staff people who will be overseeing the project and the administrative duties of the grant.

The City has previously received TGM funding for the 2012 Transportation System Plan update (2C-09). This prior project was well-administered and match funding provided by the City for completion. The City expects that this project will have similar funding requirements and needs, which have been budgeted for the 2019/2020 biennium. Similarly, the City has also previously received TGM funding for its 1993 TSP Update (3B-93), Downtown Development Plan (2K-97), TSP Completion Project (2L-97), Downtown Development Plan Phase 2 (2BB-99), Rhody Drive Integrated Transportation Plan (2Q-05). The previous TGM-funded projects were accomplished satisfactorily and within the established grant timelines.

Required formsTitle VI: Racial & Ethnic Impact Statement formRacial-Ethnic-Impact-Statement.pdf

Download the Racial & Ethnic Impact Statement form here

Today's date7/30/2020

If you encounter any issues with the submittal process, please contact:

Abigail EricksonPlanning Section Web CoordinatorAbigail.ERICKSON@odot.state.or.us

Page 1 of 2 Resolution No. 10, Series 2020

CITY OF FLORENCE RESOLUTION NO. 10, SERIES 2020

A RESOLUTION ESTABLISHING APPROVAL TO APPLY FOR A GRANT FROM

THE DEPARTMENT OF LAND CONSERVATION AND DEVELOPMENT AND OREGON DEPARTMENT OF TRANSPORTATION’S TRANSPORTATION AND

GROWTH MANAGEMENT PROGRAM FOR A TRANSPORTATION SYSTEM PLAN UPDATE AND DELEGATING AUTHORITY TO THE CITY MANAGER OR DESIGNEE

TO SIGN THE APPLICATION.

RECITALS:

1. The Department of Land Conservation and Development / Oregon Department of Transportation’s Transportation and Growth Management Program is accepting TGM planning grant applications.

2. The City of Florence desires to participate in this grant program to the greatest extent possible as a means of evaluating the City’s Transportation System Plan, transportation networks, and preparing for future growth and development opportunity.

3. The City of Florence desires a transportation system and Transportation System Plan that meets or exceeds the requirements of the State of Oregon’s “Transportation Planning Rule” (OAR 660-012-0045).

4. Application by the City of Florence will allow the City to comply with the Transportation Planning Rule for implementation of the City’s Transportation System Plan.

5. The City of Florence is committed to partnering with its partner local, county, and state agencies to accomplish transportation planning.

6. The City of Florence has available local matching funds to fulfill its share of obligation related to this grant application should the grant funds be awarded.

7. The City of Florence will provide adequate funding for this planning project should the grant funds be awarded.

Based on these findings,

Page 2 of 2 Resolution No. 10, Series 2020

THE CITY COUNCIL OF THE CITY OF FLORENCE RESOLVES AS FOLLOWS: 1. The City Council demonstrates its support for the submittal of a TGM planning grant application to the Oregon Department of Transportation & Department of Land Conservation and Development for the 2020 TGM Planning grant cycle. 2. This Resolution takes effect immediately upon adoption. ADOPTION: This Resolution is passed and adopted on the 18th day of May 2020.

___________________________ Joe Henry, Mayor

Attest: ______________________________ Kelli Weese, City Recorder

TRAVEL LANE COUNTY 754 Olive St ⚫ PO Box 10286 ⚫ Eugene OR 97440 ⚫ T | 541.484.5307 ⚫ EugeneCascadesCoast.org

April 20, 2020 Transportation and Growth Management (TGM) Program ODOT Mill Creek Building 555 13th Street NE, Suite 2 Salem, OR 97301 TGM Grant Committee Members, Travel Lane County is pleased to support the City of Florence in its application for Transportation Growth Management funds in order to update the City’s Transportation System Plan. The types of projects that will be identified and prioritized in the new plan will help improve quality of life for Florence residents while also making the city a more attractive and sustainable visitor destination. Travel Lane County works to promote the tourism industry as a key sector of Lane County’s economy. We understand the importance of tourism jobs in Florence and our other communities, and we strive to stay on top of industry trends so that we can work with our local stakeholders to respond to these issues. Across the nation there is a growing demand for more sustainable access to recreation sites, including using public transportation, and in our own visitor centers in Eugene and Springfield our staff fields many questions about how visitors and Lane County residents can get to Florence and the Oregon Coast via public transportation.

A new bus route operated by Lane Council of Governments has begun service this year between Eugene and Florence. Along with the Florence to Yachats Connector, the local Rhody Express bus, and bus service down the Southern Oregon Coast, public transportation options from the Valley to the Coast and along the Coast have increased in recent years. However, the City of Florence’s most recent transportation plan pre-dates each of these services and does not reflect the current needs and travel behaviors of residents and visitors. Additionally, planning work has continued over recent years on the Oregon Coast Bike Route and the Oregon Coast Trail. These iconic, statewide travel initiatives have identified areas that need improvement for hikers and bicyclists in Florence and elsewhere. By updating its transportation plan, the City of Florence will be able to align itself with two major tourism projects that will provide incredible recreational opportunities for residents and visitors alike. I strongly encourage you to support the City of Florence’s request for grant funds to update the Transportation System Plan. The projects identified and prioritized by that planning effort will provide a higher quality of life for Florence residents as well as a more pleasing experience for the many visitors who contribute to the local economy. Sincerely,

Kari Westlund President & CEO

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Stephanie WatkinsChief Executive Officer

CONFEDERATED TRIBES OF

coos, LowER UMPQUA AND SIUSLAW INDIAI{S1245 Fulton Avenue - Coos Bay, OR 97420

Telephone: (541) 888-1305 Toll Free 1-888-280-0726 Fax: (541) 888-2853

Iuly 1,2020Transportation and Growth Management (TGM) ProgramODOT Mill Creek Building555 l3tt'Street NE, Suite 2Salem, OR97301

TGM Grant Review Committee:

As Chief Executive Officer of the Confederated Tribes of the Coos, Lower Umpqua, and SiuslawIndians ("Tribes"), I provide this letter in support of the City of Florence's application for fundingconsideration under the Tlansportation Growth Management (TGM) program. The Tribes continue tosupport the City of Florence in a number of different ways. With regards to transportation, the Tribes

were heavily involved in the coordination that resulted in the recently proposed intercity transit service

to Florence.

The process of updating the City of Florence Transportation System Plan allows for a robust publicdiscussion on a number of substantial local transportation initiatives. The Tribes are excited to supportand participate in this process. Communication and coordination at a regional scale often leads to apositive outcome. The process may indeed influence the significant economic investments being madein the Florence Community.

Respectfully Submitted,

July 15, 2020

Transportation and Growth Management (TGM) Program ODOT Mill Creek Building 555 13th Street NE, Suite 2 Salem, OR 97301

TGM Grant Committee Members:

Lane Transit District strongly supports the City of Florence’s TGM grant application to update the City’s Transportation System Plan (TSP). Lane Transit District works closely with the City of Florence to provide Florence’s Rhody Express public transit service, as well as exploring efforts to extend District services to Florence. Previously, the City and District have coordinated other efforts regionally, including the Florence/Yachats Connector.

Lane Transit District has identified the need for system enhancements within the City of Florence that will facilitate both the expansion of the Rhody Express and current and future inter-city transportation options. We feel that improvements to the City of Florence’s TSP will lead to greater success for both agencies by providing planning continuity between our agencies for the best possible public transportation system for Florence residents.

Thank you for your consideration.

Sincerely,

Tiffany Edwards Intergovernmental Relations Manager Lane Transit District 1080 Willamette Street Eugene, OR 97401

400 Ninth Street, Florence, OR 97439 541-997-8412 Phone

peacehealth.org/peace-harbor

Transportation and Growth Management (TGM) Program

ODOT Mill Creek Building

555 13th Street NE, Suite 2

Salem, OR 97301

July 15, 2020

Dear TGM Grant Committee Members:

PeaceHealth Peace Harbor Medical Center stands behind the City of Florence’s TGM grant application to

update the City’s Transportation System Plan (TSP). Our hospital creates plans with our patients that

emphasize the importance of healthy, active lifestyles; this includes incorporating active modes of

transportation such as biking and walking into their daily lives. The current transportation system in Florence

does not provide adequate sidewalks or bike lanes that are safe and/or connected, and an updated

Transportation System Plan would support this important work.

Peace Harbor’s Community Health Board, which includes Florence City Manager Erin Reynolds, has great

interest in Dan Buettner’s Blue Zone philosophies. Buettner’s research highlights that citizens of certain

communities have longer lifespans due to six shared characteristics and among them are moderate, regular

exercise and social interaction. These two characteristics rely heavily on well-connected and walkable

communities, which would be a priority in an updated Transportation System Plan from the City of Florence.

Peace Harbor Medical Center is 100% behind the City of Florence’s application for the Transportation

Growth Management program. This is in the best interest of our citizens, our patients and the community

at large.

Thank you for your consideration,

Jason Hawkins

Chief Administrative Officer

Peace Harbor Medical Center, Florence, Ore.

Siuslaw School District 97J 2111 Oak Street, Florence, Oregon 97439 Phone 541-997-2651 - Fax 541-997-6748

www.siuslaw.k12.or.us

June 24, 2020 Transportation and Growth Management (TGM) Program ODOT Mill Creek Building 555 13th Street NE, Suite 2 Salem, OR 97301 Dear Reviewers, Siuslaw School District is pleased to support the proposed update to the Transportation System Plan as proposed by the City of Florence. This grant will assist in providing necessary upgrades for non-vehicle transportation in our community. Florence is a ‘city in motion’ and creating more safe, active transportation modes for students to cross US-101 and will make walking and biking to and from school more appealing to students, and also their parents. Students that live east of US101 must cross the highway to get to all three schools (elementary, middle & high school) on the west side each morning and back again each afternoon. The posted speed limit between 21st and 30th streets on US101 is 35 mph and the US 101 has five travel lanes (2 lanes north bound, 2 lanes south bound, and one middle turn lane). Additionally, actual vehicle speeds exceed 40 mph in this area, regardless of the school zone signs. The combination of the amount of traffic, travel speeds and width of roadway to cross places our children at increased risk for injuries. Along the ‘school section’ of US101 there are only two traffic control signals, one at 21st St and another at 35th St to bracket the school zone area. While there are improvements being made to increase safety crossing Highway 101 with mid-block crossings and sidewalks from the highway to Oak Street as part of a current Safe Routes to School project, much more is necessary to make walking and biking to school a safe alternative for students of all ages. All of our schools are located in close proximity and any safety improvements will add more active modes of transportation into the City of Florence’s Transportation System Plan. We appreciate your time. Sincerely,

Andrew Grzeskowiak Superintendent

RACIAL AND ETHNIC IMPACT STATEMENT This form is used for informational purposes only and must be included with the grant application.

Chapter 600 of the 2013 Oregon Laws require applicants to include with each grant application a racial and ethnic impact statement. The statement provides information as to the disproportionate or unique impact the proposed policies or programs may have on minority persons1 in the State of Oregon if the grant is awarded to a corporation or other legal entity other than natural persons.

1. The proposed grant project policies or programs could have a disproportionate or unique positive impact onthe following minority persons:

Indicate all that apply:

Women Asians or Pacific Islanders Persons with Disabilities American Indians African-Americans Alaskan Natives Hispanics

2. The proposed grant project policies or programs could have a disproportionate or unique negative impact onthe following minority persons:

Indicate all that apply:

Women Asians or Pacific Islanders Persons with Disabilities American Indians African-Americans Alaskan Natives Hispanics

3. The proposed grant project policies or programs will have no disproportionate or unique impact on minoritypersons.

If you checked numbers 1 or 2 above, please provide below the rationale for the existence of policies or programs having a disproportionate or unique impact on minority persons in this state. Further provide evidence of consultation with representative(s) of the affected minority persons.

By checking this box, I hereby certify the information contained on this Dated: form is true, complete, and accurate to the best of my knowledge.

Printed Name: Title:

Agency Name:

1 “Minority person” are defined in SB 463 (2013 Regular Session) as women, persons with disabilities (as defined in ORS 174.107), African Americans, Hispanics, Asians, or Pacific Islanders, American Indians and Alaskan Natives.