Kane County, IL · Kane County
Health Impact Assessment Proposal Form
Kane County municipalities use this proposal form to describe a plan, program, or policy for a Health Impact Assessment.
At a glance
- Issued by
- City of Kane County · Kane County, Kane County, Illinois
- Notarization
- Not required: file this form without a notary.
- Official source
- kanecountyil.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets a municipality propose a Health Impact Assessment project in partnership with the Kane County Planning Cooperative and the Chicago Metropolitan Agency for Planning. It asks for applicant and contact details, a project description, anticipated health indicators, the decision-making timeline, stakeholder partnerships, and other relevant information. The form states a submission deadline of March 21, 2014.
Who needs it
A Kane County municipality seeking to propose a Health Impact Assessment project should complete and submit this form.
How to submit it
The form says to email the completed proposal to Mark VanKerkhoff at [email protected], or mail it to the Development & Community Services Department, Kane County Government Center, Bldg. A, 719 Batavia Ave., Geneva, IL 60134.
About notarization
No notary is required; the form does not mention a notarized or sworn attachment, or specify a signature or date line.
How to submit this form
- 1
Download the Form
Download the Health Impact Assessment Proposal Form PDF.
- 2
Complete the Proposal
Provide applicant and contact details, describe the proposed project, and answer the timeline and stakeholder questions.
- 3
Gather Any Extra Pages
Attach a separate sheet for the project description if needed; the form says to limit that response to two pages or less.
- 4
Submit to the County
Email the completed form to Mark VanKerkhoff or mail it to the department at the address listed on the form.
Frequently asked questions
- What is the Health Impact Assessment Proposal Form for?
- It lets a municipality propose a Health Impact Assessment project and explain the plan, program, or policy the assessment would address.
- What information does the proposal form request?
- It asks for applicant and contact information, a project description, anticipated health indicators, the decision-making timeline, stakeholder partnerships, and other relevant details.
- How do I submit the Health Impact Assessment proposal?
- The form gives an email and a mailing address for Mark VanKerkhoff in the Development & Community Services Department. It also lists March 21, 2014, as the deadline.
- Do I need a notary for the Health Impact Assessment Proposal Form?
- No. The form does not mention a notarized or sworn attachment, or specify a signature or date line.