Attachment 1

TheOffice use only:

Date Rcvd:

Application #:

Region:

Amt allotted:

Instructions are in italics. Delete all italics before submitting application. Items in bold must stay. Tables may be used to provide information. Contact the appropriate local Area Wildlife Manager for DNR Project Proposal Number for work on WMAs.

Today’s Date
Project Title
Organization
Contact Person / Phone Number
Mailing address / Street address / Fax Number
City, state, zip
Email address
DNR Contact / Area wildlife manager name

LOCATION: WMA, land unit, or landowner name,and county. A table similar to the one below can be used, or reference and attach a separate page (Excel can also be used). Add rows as needed.

County / Unit or parcel name / # Sites / # Acres
TOTALS

or other State Wildlife Management Areas or location approved by the State’s representative. (Written approval by the State’s representative is required for changes.)

PROJECT DESCRIPTION:

This section gives a detailed narrative description of what you are going to do.

Also describe who will do what (contractors, volunteers, etc.) for each step, how, and when it will be done. Be sure to include the benefits of the project to various species and habitats.

A limited number of maps and photos are helpful but do not embed them in the application form. Maps or photos should be sent as separate documents or attachments, with the club name, project title, and DNR project proposalnumber (for work on WMAs) listed at the top of each document.

PROJECT TIME LINE: (What activity)is scheduled to begin(when). Include a timeline of when events will occur on each site. What will be done, how many acres or how much this year, next year, etc. Can be combined into Project Description if it is easier, or put into a table.

This project will be completed by June 30, 2012

REPORTING: Grantee will provide annual progress reports, after consultation with the Area Wildlife Manager no later than August 1 of each year. A final report for all work is due no later than August 1, 2012.

Cells will expand as you type. To total columns, place cursor in cell on total line

and press F9.

Grant Funds / Other Contributions (Donations, other funds etc.) / Total
Paid Club Staff (Explain) / $ 0.00
Contracts / $ 0.00
Equipment Rental / $ 0.00
Supplies (Specify e.g. seed, trees etc.) / $ 0.00
Other (Include DNR labor, equipment, supplies, etc.) / $ 0.00
Total project cost / $ 0.00 / $ 0.00 / $ 0.00

Signature: I certify that I have read the Heritage Enhancement Grantsto Local Outdoors Clubs / Turkey Stamp Habitat Grant Program Manual and other program documents, and am authorized by ______(Club name) to apply for and manage this grant.

I also certify that I have discussed this project with the public land manager and/or private landowner, and have their permission to do the work.

(If applying electronically, you certify this by typing in your name and date below.)

Signature ______/ Printed Name
Title / Date

Ver. 0110