GEORGIA LAND CONSERVATION PROJECT PROPOSAL

AGENCY EASEMENT GRANT APPLICATION FORM

  1. Contact Information

Project Name

Applicant Name

Contact Name and Title

Street AddressP.O. Box

City, County, Zip

PhoneFax

E-Mail

  1. Current Landowner (s)

Current Landowner or Legal Designee

3. Tract(s) Information

County

Land Lot(s) (if available)Acreage

4. Does the proposed project meet any of GLCP’s ten program goals?

_____ Surface water quality protection / _____ Prime agriculture/forestry lands
_____ Flood protection / _____ Cultural and historic resources
_____ Wetlands protection / _____ Scenic protection
_____ Erosion reduction / _____ Provision of recreation
_____ Habitat for native species / _____ Connectivity

5. Briefly describe the past and current uses of the tract(s).

6. Describe the outcome of the proposed project – who will own the property or hold the conservation easement?

7. Briefly summarize the current status of the proposed project.

8. Describe any unique urgency or opportunity associated with the proposed project.

9. Proposed Project Funding Summary

Funding / Amount
Estimated project cost / $
Estimated GLCP funding needed / $
Estimated total fair market value of tract(s) or easement / $

10 . Signature

Note: Project Proposalswill not be considered by the GeorgiaLand Conservation Council for immediate grant funding,butwill be reviewedby GLCP staff in order to determine eligibility for future funding and for possible referrals to other funding sources. GLCP funds will not be approved until a full and complete application is received, the property isvisited and scored, an agreement has been reached with the landowner and the applicant submits a qualifying appraisal.

For conservation easements, terms must be negotiated with the landowner prior to conducting an appraisal and approved by GLCP staff. State agencies must also obtain approval from the State Properties Commission and execute the easement before receiving a reimbursement grant through GLCP.

To be signed by Applicant

I certify that I am authorized to sign this proposal on behalf of our governing body and all information is correct.

Signature of authorized officialPrint or type name

Date