NORTHERN LARIMER COUNTY HABITAT PARTNERSHIP PROGRAM - APPLICATION FORM 2008b

Please complete all sections.

Form Information:
Your Name:
Email:
Project Information
Project Title:
Brief Project Description:
Responsible person(s)/partners:

Location(s): Township
Location(s): Range
Location(s): Section
Submittal Date:
Is this project Public or Private? Public Private
Private Landowners in Project:

Dates of Project : Date Initiated Date Completed
Issue Conflict With Livestock: Elk Deer Pronghorn Moose Other
Project Benefits: Agriculture Wildlife
Habitat Type: Grassland Shrubland Riparian Forest Agricultural Land
Habitat Use: Elk Winter Spring Summer Fall
Habitat Use:Deer Winter Spring Summer Fall
Habitat Use: Antelope Winter Spring Summer Fall
Habitat Use: Moose Winter Spring Summer Fall
Habitat Use: Other Winter Spring Summer Fall
Pre-evaluation and/or project justification:
Post-evaluation:
   
Project Descriptions
1) Describe the project (nature, goal and scope of project). If there are design specifications, please describe and or attach design drawings.
2) What are the benefits of this project?
3) How will this project specifically benefit wildlife?
4) What is the dollar amount that you are requesting from the Northern Larimer County HPP for this project?
5) Please estimate the final project cost and the sources of dollars to complete the project, including in-kind contributions.
6) If applicable, what do you anticipate your maintenance costs to be and will you be able to fund on going maintenance?
7) How does this project support or increase current management on the property or adjacent properties?
8) How will this project be evaluated for success?
9) Additional comments:
   
Additional Information
Person completing application:
Name:
Address:
Phone:
Location where work is to be completed or where goods are to be shipped:
Name:
Address:
Phone:
Project Contact:
Name:
Address:
Phone:
Fax:
Email:
Suggested Vendor Name:
Vendor Name:
Mailing Address:
Payment Remit Address:
Vendor FEIN or SS#:
For questions, contact Mark Leslie 970-290-0281