NAME OF LEAD DISTRICT:

Partnering District(s) if applicable:

Date of Application (mm/dd/yy):

PROJECT TITLE:

CONTACT PERSON FOR QUESTIONS REGARDING APPLICATION:

Name:

Phone:

E-Mail:

District Address:

DISTRICT BOARD PRESIDENT:

Name:

Phone:

E-Mail:

President certifies that District is in “Good Standing” with the State [meeting all statutory requirements according to Colorado Revised Statute Title 35, Article 70 (Conservation Districts) and Title 32, Article 1 (Special Districts)]

If District has submitted more than one application, list priority of this project if desired

(1 = highest):

BE SURE TO ANSWER ALL QUESTIONS; ENTER NONE OR N/A for questions that do not apply to your application.

STATEMENT OF WORK

Fill outthe form electronically by typing in the grey expandable fields after each question. Answer all

questions relevant to your project or type N/A in the field if not applicable to your project.

Proposals that do not follow the correct format will not be evaluated

CONSERVATION DISTRICT

Acronyms – please list any acronyms used in application and spell out in full

Project Overview - checklist

(a)Does the project address items in the district annual or long range plan?

YES NO

(b)What is the natural resource concern(s) being addressed (maximum 3)?

(c)State the project goal and objectives for reaching that goal

Goal (broad, general intention):

Objectives (precise, tangible, measurable outcomes related to Goal):

1.

2.

3.

Project Overview–limit 2,500 characters (approx 25 lines)

Describe what the project is and why it is important. Describe for what the CSCB matching funds would be specifically used.Describe the activities that will take place.Since funding is strictly for educational projects, describe the behaviors you want to influence. Describe how this project ties in with any past efforts in the community around similar issues. Describe how local stakeholder involvement influenced the decision to implement it. Describe any future efforts planned to contribute to the effectiveness of this project goal.

CSCB Funds will be used for:

Overview of project:

Project Methodology – limit 2,500 characters (approx 25 lines)

Describe how the project will be implemented tomeet the objectives. How will the district identify and reach your target audience? How will you deliver the educational information? How will you measure if behavior changes or critical understanding occurs as a result of the education effort?

Provide a timeline that identifies beginning and completion date and times for key identified activities/objectives.

Adequacy of Resources

List any key resources (what) identified by the district necessary for the success of this project. Identify who is providing resource and its level of certainty of being provided (in process, secured, unsecured at this time, etc.). Note in “Status” column if an MOU (Memorandum of Understanding) or other type of agreement is signed or will be signed.

Key Resource / Provided By / Status of Procurement

List key personnel identified by the district necessary for the success of this project – at minimum a project manager must be identified.

Key Personnel Name / Activity/Responsibility / Relationship to District

Briefly describe any relevant experience the district has in implementing a similar project to the one being proposed.

Partnerships

List partners involved in the project, their specific contribution (including landowners and NRCS) and status of commitment for the contribution.Note: you may list state partnerships but remember their contributions cannot be used as match and so do not include them in the budget section.

Partner / Item/Service Provided / Status of Commitment

Measurable Deliverables

For educational efforts, who and how many people will be influenced in what way? For example, 50 landowners attend seminar; 500 people receive noxious weed fact sheet, etc.

For educational efforts, what are the measurable behavioral changes to be accomplished? For example, 70% of seminar attendees will report having taken new energy savings measures within six months of attending seminar; on post-seminar mini-test 90% of people will be able to identify leafy spurge, musk thistle, toadflax and yellow starthistle in vegetative and flowering stages, etc.

Financial (ALL budget informationshould besubmitted on separate Budget form)

Be sure to complete ALL tabs in the Application Budget form (Excel document); see CSCB website

Optional - Pictures (provide as an attachment, maximum of 3; IMPORTANT - identify each picture individually)