2. Name*
3. Email Address*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number*
12. Fax Number
14. 1. Type(s) of Donation:*

    1. Monument
    2. Plaque
    3. Artwork

    1. Bench
    2. Other
16. 2. Description of Donated Art / Monument

    A written description of the background/historical information associated with any proposed donation including but not limited to, the historical and/or present relationship of the event(s) or person(s) to be memorialized and the Town of Westford; a description of the individual, group or organization sponsoring the donation and its relationship to Westford; and information about the fabrication of the item(s) and materials used. Additional information may be attached. (Models and/or pictures are to be attached or submitted with the proposal.) 

18. If a plaque or other inscribed marker is proposed in this project, please complete the following:  

20. Plaque Exact Wording:
22. Size of Plaque:
24. Plaque Material:
26. 3. Name and address of party fabricating the item to be donated: *
28. 4. Proposed location for Donation: (Please prioritize.)
30. Priority 1
32. Site:
34. Specific Location (Please attach a map.)
36. Justification of Geographic Location:
38. Priority 2
40. Site:
42. Specific Location (Please attach a map.)
44. Justification of Geographic Location:
46. Priority 3
48. Site:
50. Specific Location (Please attach a map.)
52. Justification of Geographic Location:
54. 5. Project Budget
56. Site Preparation Required and Cost:
58. Foundation of Footing and Cost:
60. Donated Art / Monument Memorial and Cost:
62. Electricity Required and Cost:
64. Lighting Reqired and Cost:
66. Maintenance/Endowment:

    Note: A maintenance plan must be attached, including an estimate of annual maintenance costs and the donor’s plans for funding the same. 

68. Other:

    Please be specific.

70. Total Project Cost
72. 6. Cost Exclusion:

     Please list any cost or part of the project that will not be provided by the donor. 

74. 7. Additional Assistance/Employment Required:

    Please list any additional party(s) hired or employed to assist with work. 

76. 8. Funding of the Donation

    Please provided detailed information as to the funds now available for this donation and/or the anticipated time necessary to raise the funds and the anticipated fund-raising activities. 

78. 9. Time Constraints or Restrictions.

    Please advise if the donation or fundraising is subject to any time constraints or restrictions. 

80. 11. Upload an Image:

    (all file types are accepted)

82. Consent Acknowledgement*

    By checking the "I agree" box below, I hereby acknowledge that I have read the Monuments and Memorials on Town Property Policy (tbd 12/13/2022), and that I will comply with all requirements thereof.
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field