I. CONTACT INFORMATION
Landowner/Manager Name
Mailing Address
Daytime Phone # / Alternate Phone # / Email
II. PROPERTY and PROJECT INFORMATION
PropertyName and Address /
Project Name
Project Location / County / UTM E N Do Not Use T,R,S
Other Location Information
Property and Project Acreage Information / Private / Total AcresOwned
Public / Acres / BLM USFS CPW SLB ______
III. PROPOSED PROJECT FUNDING(Do not include money from previous or future projects/phases)
  1. TOTAL HPP Contribution Being Requested $
**Requests >$5k require additional approval BEFORE work can begin** / HPP is paying for labor materials or reimbursing the landowner
2. Project Cooperators/Partners / Match $ / In Kind $ / In KindHours
Landowner/Land Manager/Applicant / $ $
What will the Contribution be Used For?
Partner 1 / $ $
What will the Contribution be Used For?
Partner 2 / $ $
What will the Contribution be Used For?
Partner 3 / $ $
What will the Contribution be Used For?

GRAND TOTAL (1+2) $ $ / Hours

Match $ - real dollars paid to a 3rd party as a part of the cooperator’s contribution

In Kind $ - the value of services or labor that the landowner or cooperator contributes as determined by them.

Hours – the amount of time that a cooperator contributes to the project as their partnership contribution. Do not count both in kind $ and in kind hours for the same work.

EVALUATION AND JUSTIFICATION OF PROPOSED PROJECT

HPP exists to assist agricultural landowners with conflicts caused by deer, elk, pronghorn and moose and to assist CPW achieve management objectives for those same species. Your project must meet at least one of these purposes in order to be considered.

Please describe what you want to do for your project.
Which purpose of HPP does your project address? / Agricultural conflict caused by deer, elk, pronghorn, moose
Assist CPW achieve deer, elk, pronghorn, moose management objectives
Describe how the project will be monitored for success.
What are the benefits to the landowners?
What are the benefits to wildlife and/or habitat?
Will your project change big-game distribution? Describe.
Will your project reduce or eliminate game damage or the filing of claims? Explain.
If on private land, does the landowner allow hunting? / Yes Explanation:
No
Is your project within designated habitat for either Gunnison Sage Grouse or Greater Sage Grouse? / Yes, within Gunnison Sage Grouse designated habitat
Yes, within Greater Sage Grouse designated habitat
No, not within either Gunnison or Greater Sage Grouse designated habitat
Project Reviewed/Approved by CPW and/or USFWS
Conflict Wildlife / Elk Deer Pronghorn Moose
Habitat Type / Ag Crop Aspen Conifer Forest Irrigated Hay Meadow
Mtn Shrub Pinyon/Juniper Riparian Sagebrush Wetland
Habitat Use / Elk
Deer
Pronghorn
Moose / Winter Summer Fall Spring
Please mark the box that best describes your proposed fencing project:
Cattle Guards/Gates Miles of New Fence Vinyl Rolls of Wire
# requested how many miles? # rolls needed
Corrals Exclusionary Fence Repair Project
# requested CPW Approval Needed
A materials list and cost estimate is required for fencing projects.
Please talk with your committee about wildlife friendly fencing ideas.
What are you asking HPP to Buy?
Quantity / Unit / Description / Unit Cost / Amount
TOTAL (must match HPP request from Page 1) $
Tentative Start Date: Probable Completion Date:
Landowner/Land Manager/Applicant Signature and Date: I understand that local, state and/or federal permits may be required for this project. It is my sole responsibility to have the appropriate permits in place prior to the project starting.
DWM Review/Approval:
HPP Committee Review/Approval/Comments:
Materials Obtained from: _____ Private Vendor ____ Game Damage
Final Approval if different from Request:
Project Notes:
Project Estimate different than Vendor Quote:
Preferred Vendor: Is vendor a former or current state employee? Y N

NOTE: Your local committee may have specific project requirements, ie. before and after photos, soils test for fertilizer requests, ‘wildlife friendly’ fence specifications, minimum acreage, hunting allowed, DWM review, etc. Please check with them to see if your property and your project meet their specific conditions.

NOTE: Due to Federal and State concerns about Gunnison Sage Grouse and Greater Sage Grouse further reviews are needed before HPP can approve your project. If your project is within designated habitat for either species, please check with your DWM or HPP administrative assistant for further information. Review and approval by CPW and USFWS is needed prior to your project starting