STIP Amendment Request Form

All fields in the online request form must be complete before IMD will approve the Program Development Unit to process the request and add the project to the NC DOT Board of Transportation (BOT) meeting agenda. Incomplete request forms will be returned for completion and may not be included on the BOT meeting agenda until the following month if not received by the submission deadline. *STIP Amendment Requests must be received by the first of the month to be included on the next month's BOT Handout.

STIP Request Number*

Is this a new or existing request?*

Select

If it is an existing request, does it already have a different STIP Request Number?*

Select

What is the Existing STIP Request Number?*

MPO/RPO*

Select

If Multiple MPOs/RPOs, Percentage Breakdown

If project involves multiple counties, please list the percentage of funding per county.

County/Counties*

Select

If Multiple Counties, Percentage Breakdown

If project involves multiple counties, please list the percentage of funding per county.

Date*

Contact Person*

Contact Email*

Transit Partner*

Project Description*

with Route Description, if applicable.

Specific Action*

Copy one of the following and Paste below. Then replace XX's with exact data: *ADD PROJECT XX-XXXX TO STIP FOR FFYXXXX. NEW PROJECT DEVELOPED FOR FEDERAL FUNDING AWARD. PROJECT ADDED AT REQUEST OF XXX MPO. *ADDED CMAQ FUNDING TO FY XX NOT PREVIOUSLY FUNDED AT THE REQUEST OF THE XXX MPO *ADDED CONSTRUCTION FUNDING TO FY XX NOT PREVIOUSLY FUNDED AT THE REQUEST OF THE XXX MPO *ADDED PLANNING FUNDING TO FY XX NOT PREVIOUSLY FUNDED AT THE REQUEST OF THE XXX MPO *FUNDING ADDED TO FY XX AT THE REQUEST OF XXX MPO. *MODIFYING THE DESCRIPTION AT THE REQUEST OF THE MPO *MODIFYING THE FEDERAL FUNDS RECEIVED FROM FTA ADMINISTERED BY PTD BASED ON FY XXX GRANTS *MOVING FUNDS FROM FY XX TO FY XX IN THE AMOUNT OF XXX AT THE REQUEST OF THE XXX MPO *PROJECT PARTNER DELAYS FUNDING MOVED FROM FY XXX TO FY XXX AT THE REQUEST OF THE XXX MPO *REDUCING FUNDS IN FY XX AT THE REQUEST OF THE MPO

Activity/Work Type*

Select

Federal Funds Source*

Specific Source of Funds

Select or enter value

State Funds Source

Specific Source of Funds

Select or enter value

Local Funds Source*

Specific Source of Funds

FY25 Federal Share

(whole number in thousands)

FY25 State Share

(whole number in thousands)

FY25 Local Share

(whole number in thousands)

FY26 Federal Share

(whole number in thousands)

FY26 State Share

(whole number in thousands)

FY26 Local Share

(whole number in thousands)

FY27 Federal Share

(whole number in thousands)

FY27 State Share

(whole number in thousands)

FY27 Local Share

(whole number in thousands)

FY28 Federal Share

(whole number in thousands)

FY28 State Share

(whole number in thousands)

FY28 Local Share

(whole number in thousands)

FY29 Federal Share (whole number in thousands)

(whole number in thousands)

FY29 State Share

(whole number in thousands)

FY29 Local Share

(whole number in thousands)

FY30 Federal Share

(whole number in thousands)

FY30 State Share

(whole number in thousands)

FY30 Local Share

(whole number in thousands)

FY31 Federal Share

(whole number in thousands)

FY31 State Share

(whole number in thousands)

FY31 Local Share

(whole number in thousands)

FY32 Federal Share

(whole number in thousands)

FY32 State Share

(whole number in thousands)

FY32 Local Share

(whole number in thousands)

Type of Agenda Action*

Select

MTIP Approval Date

MTIP resolution must be approved prior to submitting this request form.

Request Attached?

Select

Resolution Attached?*

Resolution must be attached.

Select

Signature*

Electronic signature acceptable - type full name

Signature Date*

File Attachments*

Resolution must be attached. Any other project supporting documentation optional.

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