Deer PLAN Grant Program Application
/ Michigan Department of Natural ResourcesWildlife / Grants Management
2018 Northern Lower Peninsula
Deer Private Land Assistance Network Grant Application
This information is required by authority of Part 5 of Act 451, P.A. 1994 as amended, to receive funds. / FOR DNR USE ONLY
Application Number
Date Received
The information requested in this application is important in the evaluation of your proposal. Incomplete documentation could result in the proposal being scored at a lower priority or removed from consideration. For additional information, refer to the document entitled Deer PLAN Handbook.
PART I: GENERAL INFORMATION
1. Applicant Information:
Private Individual(s) / Cooperative/Multiple Property / Nonprofit Organization / For Profit Organization
Name of Applicant/Organization / Organization Tax Identification No.
Authorized Representative’s Name and Title (Person responsible or in charge of the grant. If a nonprofit organization or government agency, name of
the person representing the organization).
Address / Telephone
( ) / FAX
( )
City, State, ZIP / Email
Note: Written documentation of third party landowner permission for the proposed activity must be included where necessary
2. PROPERTY OWNER Information: (if different than applicant) (add additional sheets as necessary for additional owners)
Name of Property Owner(s) / Telephone
( )
Address / FAX
( )
City, State, ZIP / Email
3. PROJECT LOCATION: Provide the site location information requested below and attach a Project Location Map (e.g. air photo) that includes: project location, and if applicable, proximity to public hunting land and/ or proximity to active farmland to enable inspection of the project site
Project Address (road, if no street address) / ZIP / Municipality (Township/Village/City) / County
Property Tax Identification Number(s) / Latitude
N / Township/Range/Section (TRS)
T N or S; R E or W;
Longitude
W / Section
4. DESCRIPTION OF PROPOSAL: (Include detailed description of planned habitat improvement project and expected benefits as they pertain to the selection criteria listed in Appendix B pages 11-14 of the Deer PLAN Handbook. List any additional parties to proposal. Attach extra sheets and maps if necessary.)
· Description of Project (what will be done, when will it occur and how will it benefit deer?)
Wildlife openings w/forage plantings
Creation
Rehabilitation
Maintenance / Acres
Acres
Acres / Perennial plantings
Annual planting
Mixed annual + perennials
No planting / Acres
Acres
Acres
Mast Bearing Trees or Shrub plantings (minimum of 4 foot height required for all trees planted)
soft mast Acres # of trees
hard mast Acres # of trees / List of mast/shrub species:
Timber Harvest within the last three years Acres (minimum of 5 acres required)
Forest Stewardship Plan or equivalent has been completed and is being followed (please include copy of plan with application)
· Please include all additional project description details here:
· Describe any partnerships including cooperatives, neighbors, government/non-government agencies that will be formed or continued as a result of this project
· Public accessibility and/or proximity to public lands (how close is/are the project(s) to public land?)
· Proximity to active agricultural property (how close is/are the project(s) to agricultural land?)
· Deer Population Management - Applicant agrees to (check all that apply):
Fill out Deer Camp Survey
Fill out online Deer Hunter Harvest Survey
Harvest more antlerless deer than antlered deer for the 2017 and 2018 deer hunting seasons
Submit all deer heads for testing at a DNR check station or by setting up a time with the local biologist
Acreage of Project / Acres of property
PART II: ESTIMATED PROJECT COSTS
1. ESTIMATED PROJECT COST:
Grant Amount Requested (round to nearest $100)
$ / Local Match (round to nearest $100)
$ / Total Project Cost (round to nearest $100) (Grant Amount + Local Match)
$
1. SOURCE OF LOCAL MATCH: Specify the amount of local match from each source. (Round to the nearest $100)
General Funds (applicant’s own cash) / $
Cash Donations from others (must provide commitment letters if applicable) / $
Value of Donated Material & Labor from others (must provide commitment letters if applicable) / $
Other (please specify) (ie: applicants force account labor, materials or equipment, other grant awards, etc) / $
TOTAL LOCAL MATCH (Must equal or exceed 25% of the Total Project Cost) / $
2. Project Funding Breakdown: / ESTIMATED COST
(round to the nearest $100)
A. / Personnel Costs / $
B. / Materials & Equipment / $
C. / Contractual Items / $
D. / Other / $
$
$
$
Subtotal / $
TOTAL ESTIMATED PROJECT COST / $
PART III: WORK PLAN
To complete the Work Plan, list the work that you expect to complete during each quarter of the project. If your project is selected for funding, this schedule, along with the project budget, will be included as part of the Project Agreement.
If additional space is required, please copy this page and attach to application.
Project Period / Work Expected to be Completed During Period
First Quarter (October 1, 2017 –
December 31, 2017)
Second Quarter (January 1, 2018 –
March 31, 2018)
Third Quarter (April 1, 2018 – June 30, 2018)
Fourth Quarter (July 1, 2018 –
September 30, 2018)
PART IV: CERTIFICATION
Must be completed by the individual officially designated to act on the applicant’s or agency’s behalf.
I certify that all statements on this application and the attachments hereto are true, complete and accurate to the best of my knowledge.
Print or Type Name / Title
Signature of Authorized Representative / Date
Attach in email along with your completed application:
· Project Location Map – to enable site inspection.
· Match Commitment Letters – provide copy of commitment letters
· Proof of Property Ownership – provide copy of deed or most recent property tax statement if work to be done is located on applicant’s property.
Electronically submit your application and all other required attachments to:
Applications must be electronically submitted by 11:59pm, September 1, 2017 to be considered for funding.
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