OREGON DEPARTMENT OF FISH AND WILDLIFE
|Oregon Department |
|of Fish and Wildlife |
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|Wildlife Division |
|4034 Fairview Industrial Dr. SE |
|Salem, OR 97302 |
|503-947-6300 |
|Fax: 503-947-6330 |
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|[pic] |
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|Bird Stamp Program |
|Grant Application |
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|Grant Applications may be submitted for habitat development and improvement projects, equipment, surveys and/or research. |
| |
|Grant applications are due by |
|March 1 and September 1 of each year. |
| |
|Applications must be submitted to the ODFW Game Bird Committee Representative for the watershed in which the project will take |
|place. (See page 10 for a list of committee members.) |
Instructions for Completing Application Forms
|You must complete Sections 1-7 as follows: |
| |
|Type in the information requested or reproduce the form on your computer. |
|Use 8 1/2” x 11” single-sided, unstapled pages with the spacing and layout provided. |
|Avoid color and detail that will not photocopy clearly. |
|Sign and date the Grant Application Submittal Form. |
|Submit the application to the appropriate Bird Stamp Committee Representative listed in Section 7 |
|If applicable, you may submit the following: |
| |
|Maps (if applicable): |
|Provide a general map highlighting the location. |
|On a USGS 7.5 min topo quad map, locate the extent of your project and site specific activities. |
|Please provide maps on 8 ½” x 11” pages and include a legend. |
|Avoid color and detail that will not photocopy clearly. |
| |
|Photographs (if applicable): |
|Provide photographs to aid in understanding the situation. |
|Please note that if your project is funded, pre-project photos will be required in the final report. |
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|Project Designs (if applicable): |
|Details should match the complexity of the proposed project. |
|These must show the project placement and provide sufficient detail to allow a reasonable evaluation of the effect of the project |
|on the site proposed. |
|The design should include reference to appropriate standards and guidelines. |
| |
|Provide 5 color copies of any maps, photos or project designs that you want ODFW reviewers to see in color. |
SECTION 1 (Do Not Exceed 2 pages)
BIRD STAMP PROGRAM APPLICANT INFORMATION
This box for ODFW use only
Application Number:________________________
Reviewed by ODFW Watershed Manager: _________________________ __________________
Signature Date
Watershed Manager Comment, if any:________________________________________________
_______________________________________________________________________________
Project Title: ____________________________________________________________________
Property Information (if applicable): Owned by: ___________________________________
Address: ______________________________________________________
___________________ ____________________
County Township Range Section(s) Longitude, Latitude (if applicable)
ODFW dollars requested: ________ Total cost of project: ___________
Applicant: ____________________ Phone: ___________________ Fax: _______________
Email: ______________________________________
Applicant Address: _______________________________________________________________
Street City Zip
Mailing Address (if different):_______________________________________________
Street City Zip
Applicant Affiliation (if any): ____________________________________________________
Technical Contact (if different): ____________________
Email: ______________________ Phone: _______________________Fax: _________________
Fiscal Officer (if any):___________ Phone: ______________________Fax: _________________
Email: __________________ Address: _________________ ___________ _________
Street City Zip
In 1-2 sentences briefly summarize for what purpose you are requesting funds:
1. Was this application submitted previously? ( Yes ( No
If yes, what was the application number?________ Briefly describe what changes have been made to the project proposal.
1a. Is this project a continuation of a previously ODFW funded project(s)? ( Yes ( No
If yes, what was the application(s) number? _________
2. If there is funding being received through cost share please list all agencies and organizations from which funding is anticipated for the proposed project.
Cost Share
Agency/Organization Cash In-Kind Secured Pending $Amount/Value
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
____________________ ( ( ( ( $ .00
Total Estimated Project Costs: $ .00
2a. Briefly describe how each cost-share partner listed above is participating in the project.
_______________________________________________________________________________
_______________________________________________________________________________
3. Have any conditions been placed on other funds that may affect project completion?
( Yes ( No If yes, explain: ________________________________________________________
4. Are there additional partners (agencies, landowners, volunteers)? ( Yes ( No
If yes, what will they do? __________________________________________________________
_______________________________________________________________________________
5. What do you expect will be the public benefits of the project?___________________________
_______________________________________________________________________________
6. How will you promote public awareness about Bird Stamp benefits of the project locally?
______________________________________________________________________________________________________________________________________________________________
7. What is the proposed schedule for the project? (Include start date, critical element dates, completion date, and monitoring schedule):
______________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________
SECTION 2
BIRD STAMP PROGRAM
SPECIFIC FUNDING ACTIVITY
Please answer the following questions that apply to the funding proposal. If there are multiple locations for habitat projects, be specific for each site. (USE 8½" x 11" SINGLE-SIDED PAGES)
1. What are you proposing to do? Supply specific and sufficient detail to match the funding proposal’s complexity and technical difficulty so that its viability can be evaluated. Include who will do the project design, and whether other alternatives were considered and why this particular methodology was selected from among the alternatives considered.
2. What are the funding proposal objectives? Provide a bulleted list of measurable indicators.
3. What will be the anticipated condition of the site(s) upon project completion, and in 10 years? Be site specific.
Upon completion:
After 10 years:
4. Are there potential adverse impacts to other properties or resources as a result of this project? If yes, what are they and how have they been addressed in the project plans?
5. How will success be determined, i.e., what elements will be monitored/evaluated - by whom, how often, and for how long? How will project effectiveness be assessed? Be sure to link this to the objectives identified in # 2 above. List:
Agency/Organization Address Activity & Frequency Signature
6. Who will inspect and sign off on the completed work? Who will submit required project reports? Please provide contact information.
Agency/Organization Address Activity & Frequency Signature
7.
8. Who will maintain the project/equipment and for how long? List:
Agency/Organization Address Activity & Frequency Signature
9. Which elements of the proposal will ODFW funds be used for? This should correspond to elements in the “ODFW Funds” column on the budget sheet.
SECTION 3
BIRD STAMP PROGRAM BUDGET
Attach additional pages if necessary
|Itemized projected costs under each |Unit Number (i.e. |Unit Cost |In-Kind |Cash Match* |ODFW Stamp |Total Costs |
|applicable category: |hours, feet) | |Match* | |Funds Requested| |
|IMPLEMENTATION COSTS (Design, permits, engineering, baseline monitoring, etc) |
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|PERSONNEL (Position title, wages, benefits, etc.) |
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|TRAVEL (Mileage, per diem, lodging, etc.) |
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|CONTRACTED SERVICES (Non-employee cost for labor for: fencing, instream work, tree planting, technical consultation, project management, |
|etc.) |
| Blue Mountain Asphalt Co | | | | | | |
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|SUPPLIES/MATERIALS (Fertilizer, seed, fencing, boulders, logs, plants, etc.) |
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|OUTREACH COSTS (Video production, printing, direct mail, tours, workshops, etc.) |
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|EQUIPMENT (Items usable beyond end of the project with a value greater than $100, i.e. rain gage, thermograph, etc.) |
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|SUB-TOTALS |
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|MONITORING*** (Component to be monitored, cost per year, number of years, and total cost) |
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|TOTALS: | | | | |
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SECTION 5
BIRD STAMP
LAND USE INFORMATION SHEET
Some habitat projects may require approval by appropriate land use regulatory agencies. This form must be submitted prior to ODFW releasing project funds for habitat related projects. ODFW will only release project funds if the project either is not regulated by, or is compatible with, the local comprehensive plan and zoning ordinance. ODFW will void grant agreements for projects the county determines to be incompatible with the local comprehensive plan and zoning ordinance. If the county requires additional local approvals, ODFW will not release project funds until these conditions are satisfied.
1. TO BE COMPLETED BY THE GRANTEE
Applicant Name: ___________
Project Title: ________
2. TO BE COMPLETED BY CITY/COUNTY OR TRIBAL PLANNING OFFICIAL
Complete this section only after Section 1, above, has been completed. Check the box below that applies:
( This project is not regulated by the local comprehensive plan and zoning ordinance.
( This project has been reviewed and is compatible with the local comprehensive plan and zoning ordinance.
( This project has been reviewed and is not compatible with the local comprehensive plan and zoning ordinance.
( Compatibility of this project with the local planning ordinance cannot be determined until the following local approvals are obtained:
______ Conditional Use Permit ______ Development Permit
______ Plan Amendment ______ Zone Change
______ Other
An application has ___ has not __ been made for the local approvals checked above.
* Signature of Local Official: ________________________________________________
Title: ___________________________________ Date:____________________
*Must be authorized signature from your local City/County or Tribal Planning
Department regardless of which box is checked.
SECTION 6
BIRD STAMP APPLICATION SUBMITTAL
AUTHORIZATION
I/we,___________________________of ______________________________, Oregon, hereby make application for financial assistance under the terms and conditions of this Grant Application in the amount of $__________. The total cost of the project is $______________, as shown under Section 1.
I/we understand that if this proposal is funded, I/we will be required to:
• Sign a Grant Agreement containing the terms and conditions upon which funds
will be released, including submission of other necessary permits and documents,
a certification to comply with state, federal and local regulations, and a release of
liability for the State of Oregon;
• Obtain landowner, monitoring, and maintenance agreements (as applicable);
• Certify that the project complies with state, federal and local regulations;
• Submit written evidence that all applicable permits and licenses from local, state
or federal agencies or governing bodies have been obtained or are not needed;
• Submit a report at the completion of the project, and subsequent periodic reports
required, to ODFW;
• Agree that educational products resulting from projects are public domain.
• Use of the pictured pre-made signs for habitat projects or decals for equipment purchases is strongly encouraged. Please request from the game birds program if funding is granted.
Signed: ___________________________________ Date: _____________________
Title: ________________________________________________________________
SECTION 7
BIRD STAMP COMMITTEE REPRESENTATIVE REVIEW FORM
Please submit this application, for initial review, to the appropriate Bird Stamp Committee Representative from the watershed in which your project would occur. The representative will then forward the application to the appropriate ODFW Watershed Manager for review and signature. A list of representatives is below. If you need help determining the correct representative please contact Dave Budeau at (503) 947-6323 or David.A.Budeau@state.or.us
This box for ODFW use only
Game Bird Committee Representative: _________________________________
Date Received by Committee Rep: ____________________________
Date
Representative’s comments, if any: __________________________________________________
______________________________________________________________________________
ODFW Game Bird Committee Members
North Coast Watershed Rep
Dave Nuzum
North Coast Watershed District Office
4907 Third Street
Tillamook, OR 97141
North Willamette Watershed Rep
Mark Nebeker
Sauvie Island Wildlife Area
18330 NW Sauvie Island Rd.
Portland, OR 97231
South Willamette Watershed Rep
Wayne Morrow
Fern Ridge Wildlife Area
26969 Cantrell Road
Eugene, OR 97402
Umpqua Watershed Rep
Stuart Love
Umpqua Watershed District Office
63538 Boat Basin Drive
Charleston, OR 97420
Rogue Watershed Rep
Vince Oredson
Rogue Watershed District Office
1795 East Gregory Road
Central Point, OR 97502
Deschutes Watershed Rep
Jeremy Thompson
The Dalles Field Office
3701 West 13th Street
The Dalles, OR 97058
John Day Watershed Rep
Kevin Blakely
John Day Watershed District Office
73471 Mytinger Lane
Pendleton, OR 97801
Grande Ronde Watershed Rep
Dave Larson
Ladd Marsh Wildlife Area
59116 Pierce Road
La Grande, OR 97850
Klamath Watershed Rep
Marty St. Louis
Summer Lake Wildlife Area
53447 Hwy 31
Summer Lake, OR 97640
Malheur Watershed Rep
Autumn Larkins
Hines District Office
Po Box 8; 237 S Hines Blvd
Hines, OR 97738
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