What is the Short Environmental Assessment Form for?

Applicants or project sponsors use Part I to provide project information for an unlisted action. The lead agency completes the impact assessment and determination.

Who completes each part of the form?

The applicant or project sponsor completes Part I. The lead agency completes Part II and Part III, including the impact assessment and determination of significance.

How do I submit the Short Environmental Assessment Form?

The form does not specify a submission department or method. Submit it to the city department named on the form; check the city website for current contact details.

Deerpark, NY · Orange County

No notary required

Short Environmental Assessment Form

Applicants or project sponsors use this form to provide project details for environmental review of an unlisted action.

At a glance

Issued by: City of Deerpark · Deerpark, Orange County, New York
Notarization: Not required: file this form without a notary.
Official source: townofdeerpark.org
Blank form: Download the PDF
Catalogued: Sep 28, 2026
Machine-readable: JSON record · about the forms index

What this form is

Part I asks the applicant or project sponsor for the project name and location, a brief project description, land affected, zoning, nearby land uses, and permit information. The lead agency completes Parts II and III to assess potential impacts and determine significance. The form is for unlisted actions; it directs users to the Full Environmental Assessment Form in specified circumstances.

Who needs it

Applicants or project sponsors proposing an unlisted action provide the project information, and the lead agency completes the impact assessment and determination.

How to submit it

Submit it to the city department named on the form; check the city website for current contact details.

About notarization

This document is signed and dated without a notary; the applicant or sponsor certifies the information, and the lead agency signs its determination.

How to submit this form

1
Download The Form
Download the Short Environmental Assessment Form PDF.
2
Complete Part I
Enter applicant or sponsor details and describe the project, location, land affected, zoning, nearby land uses, and permit information.
3
Gather Supporting Materials
Attach supporting materials if needed; Part III instructs the agency to add attachments or reference supporting materials when necessary.
4
Submit To The City
Submit the completed form to the city department named on the form; check the city website for current contact details.

Frequently asked questions

What is the Short Environmental Assessment Form for?: Applicants or project sponsors use Part I to provide project information for an unlisted action. The lead agency completes the impact assessment and determination.
Who completes each part of the form?: The applicant or project sponsor completes Part I. The lead agency completes Part II and Part III, including the impact assessment and determination of significance.
Do I need a notary for the Short Environmental Assessment Form?: No. This document is signed and dated without a notary; the applicant or sponsor certifies the information, and the lead agency signs its determination.
How do I submit the Short Environmental Assessment Form?: The form does not specify a submission department or method. Submit it to the city department named on the form; check the city website for current contact details.

Need something notarized?

This Short Environmental Assessment Form doesn’t need a notary, but if you have another Deerpark form that does, a commissioned online notary can help.