Pre-Application Questionnaire
Tentative Wisconsin Plans For Broadband Grants/Loans

* Required

If this is an update to a previously submitted response, enter your confirmation number from that previous submittal:
Applicant:	*
PSCW ID#:	(if you have one)
Contact Person:	*
Contact Phone:	*   Email: *

INTENTION TO SEEK FUNDING* We will not seek NTIA and/or RUS Broadband Funding at all. If not, please Explain why --> We will not seek NTIA and/or RUS Broadband Funding in this round. We will seek NTIA and/or RUS Broadband Funding. If so, please continue below:

FUNDING DETAILS 1) What type of funding will you likely be seeking for this project? (check all that apply) We will be seeking an NTIA grant. Public computing centersBroadband sustainability projectBroadband deployment We will be seeking an RUS grant We will be seeking an RUS loan guarantee. We will be seeking an RUS loan. For the RUS project, this request relates to TelemedicineDistance learningBroadband deployment 2) NTIA/RUS Funding sought $ 3) Total Project Cost $ OVERVIEW OF THE PROJECT: Please provide a brief summary / overview of the project:      LOCATION OF THE PROJECT The project takes place in the following county(s): (check all that apply)  STATEWIDE AdamsChippewaDunnIowaLafayetteMilwaukeePolkSaukWalworth AshlandClarkEau ClaireIronLangladeMonroePortageSawyerWashburn BarronColumbiaFlorenceJacksonLincolnOcontoPriceShawanoWashington BayfieldCrawfordFond du LacJeffersonManitowocOneidaRacineSheboyganWaukesha BrownDaneForestJuneauMarathonOutagamieRichlandTaylorWaupaca BuffaloDodgeGrantKenoshaMarinetteOzaukeeRockTrempealeauWaushara BurnettDoorGreenKewauneeMarquettePepinRuskVernonWinnebago CalumetDouglasGreen LakeLa CrosseMenomineePierceSaint CroixVilasWood   DETAILS OF THE PROJECT 1) Services to be provided: (check all that apply) Retail last mile broadband accessLast mile broadband access to be used by other providersBackbone services Other      2) Customers to be served: (check all that apply) ResidencesRural businessesSchools / libraries Hospitals / clinicsGovernmental agenciesOther telecommunications / broadband providers. Other      3) When could the project start? (mm/dd/yy) 4) When could the project be completed or operational? (mm/dd/yy)   JOBS 1) Approximately how many jobs will be created / preserved by this project? 2) Please explain your estimates:        TECHNOLOGY 1) If your project includes providing broadband to end users, what technology will be used for the the last mile / connection to the customer? (check all that apply) Point-to-point wirelessBroadcast wirelessFiber optic cable / FTTHCoaxial cableCopper cable / DSL Other      2) What average data transmission speeds will the project supply? 300 kbps Up to 3 Mbps.More than 3 Mbps Up to 6 Mbps.More than 6 Mbps Up to 10 Mbps. More than 10 Mbps Up to 20 Mbps.More than 20 Mbps.

AGENCY ASSISTANCE WITH APPLICATIONS (Optional) How can the state agencies assist with your application? (check all that apply.) Assistance in verifying that areas are unserved / underserved. A review of draft applications. Assistance in navigating the NTIA/RUS application process. Other ways in which the state agencies could assist you on these grants/loans.

Comments:

If you have any question or comments on this form or the application process, please contact Gary Evenson at the PSC at: Gary.Evenson@psc.state.wi.us