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Northeast Wildlife Damage Management Cooperative Project ...

By Mark Johnson,2014-02-10 03:06
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Northeast Wildlife Damage Management Cooperative Project ...

    NORTHEAST WILDLIFE DAMAGE MANAGEMENT COOPERATIVE

    Project Application Form

    2008

Instructions:

    1. Please fill out all information completely. Failure to do so may result in a reduced

    rating or disqualification of your proposal.

    2. Please type all information.

Part A - APPLICANT INFORMATION

Name(s):

Address:

Phone:

Fax:

Email Address:

Type of Applicant (please choose appropriate designation)

    ; Business

    ; Government Agency/Organization

    ; Private Agency Organization

    ; Educational Institution

Project Staff

Please list the names and titles of all key personnel involved in your project

     1

Part B - GENERAL PROJECT INFORMATION

    1. Title of Project

    2. Type of Project

    3. Please describe the purpose of your project in 25 words or less.

    4. What is the proposed timeline for your project?

     5. What deliverables do you expect as an outcome of this project?

     2

Part C - PROJECT COST 2007 PROPOSED BUDGET

Total Project Cost: $_________________

Grant Funds Requested $_________________

Applicant Match $_________________

    Please list the sources and the amount of applicant match:

     Source Amount

    _______________________________________________ $__________________

    _______________________________________________ $__________________

    _______________________________________________ $__________________

Project Title: _____________________________________________________________________

Applicant Name:___________________________________________________________________

     Applicant Match

Expenditure Category Grant Funds Cash In-Kind Total

Salaries and Wages $ $ $ $

Fringe Benefits

Contractual

Travel (at State rates)

Supplies and Materials

Communication

Equipment

    (Purchase/Lease)

Indirect Costs (20.0%)

Other (Specify)

TOTAL $ $ $ $

Please attach budget justification if necessary

     3

Part D PROJECT DETAILS

    1. What is the need, problem, or opportunity that the project addresses?

    2. How does the proposed project resolve the problem/need or capitalize on the

    opportunity identified in this project?

    3. How does the applicant plan to carry out the project? (Describe the timeline and

    major tasks)

    4. How will the project when implemented benefit one or more of the States in the

    Northeast?

     4

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