2010 Washington State Intent Form for a

Cooperative Endangered Species Conservation Fund

Land Acquisition Proposal (this form is due June 8, 2009)

The following organization is interested in submitting a land acquisition proposal to the State of Washington for competition under the federal Cooperative Endangered Species Conservation Fund

for federal grant year 2010, and can host a site visit of the target acquisition property during the week of June 15, 2009, if requested by state or federal agencies coordinating this program.

Organization:

Address:

Contact: Title:

Phone(s): Email:

Proposal Title (geographic name):

This proposal is for a (indicate one):

____ HCP Land Acquisition grant ____ Recovery Land Acquisition grant

Grant proposal sponsorship and administration is sought through Washington State (indicate one):

Department of Fish and Wildlife Department of Natural Resources

Federal Grant Amount to be Requested: $
Non-federal Cost Share Amount: $ % Non-federal Cost Share: %
Total Project Cost: $

Acres to be Purchased: Total Acres to be Conserved (purchase + match + other):

Watershed(s): County(ies):

Are there willing sellers on the land targeted for purchase?

Are there multiple parcels and/or alternate parcels for purchase?

Identify DNR, WDFW, or USFWS personnel (name, number) working with you on this proposal, if any.

In the boxes on page 2 of this form, briefly provide detailed information about your proposed land acquisition project. The following details, from information you supply, may be posted to a state website for public information: project name, county, watershed, primary species to benefit, habitat type, acreage, partners, sponsoring agency, sponsoring organization. Do not submit more text than this 2-page form.
You must also submit 2 maps. One map should show general project location in relation to nearby federal and state lands, and any match property location. A second map should provide parcel-specific location(s) for land proposed for acquisition and for match, and should relate to the general project location map.

(Intent Form - Page 1 of 2)

2010 Washington State Intent Form for a

Cooperative Endangered Species Conservation Fund

Land Acquisition Proposal

Project Description: describe project objectives; what the land acquisition would entail; and the project’s expected benefits to fish, wildlife, and the public. Identify what would constitute non-federal match.

Project Partners: identify who is involved with the proposed project, and their respective roles.

Support: describe what local, individual, regional, community, or group support exists for this project; any known controversy or opposition to this project; and any outreach that has been conducted for this project.

(Intent Form – Page 2 of 2 – Do not submit more text than this 2-page form and only 2 maps)