Coast Range Stewardship Fund Project Application Form
Application Submission Period:
June 2, 2014 to September 2, 2014
General Directions:
Prior to submittal of this Application, the USFS Technical Specialist Pre-Application Review form
must have been submitted by August 1, 2014 to the appropriate Stewardship Group, the CPRCD and the
USFS Specialist who will provide final approval of all Pre-Applications. Application materials can be emailed and mailed upon request.
Please review the Guidelines & RFP for information on eligibility, project categories, and evaluation criteria. All documents may be found under 2014 APPLICATION DOCUMENTS located at Cascade Pacific
RC&D’s stewardship website: http://www.cascadepacificstewardship.org/multilist_42/stewardshipfund/stewardship-fund
For question R1 through R3 on page 3, utilize the appropriate Stewardship Area Map for your project
location. Maps for the Siuslaw Basin & Coastal Lakes area, the Alsea Stewardship Area, the Marys Peak
Stewardship Area and Hebo Stewardship Area are located at the above website address.
Check to ensure that the following has been complete:
USFS Technical Specialist Pre-Application Review Form (Threshold Questions for Project Eligibility)
Section I - Applicant Information
Section II - Project Information
Section III - Specific Restoration Activities
Section IV - Budget Sheet Download Excel file at www.cascadepacificstewardship.org
Section V- Match Funding Form
Section VI – Land Use Information sheet
Section VII- Landowner/Applicant Certification
Section VIII - Legal Requirements
Additional Information: Provide maps, project designs or photos as needed
Application Deadline is September 2, 2014. Submit one paper copy AND one digital copy (CD only)
of application with all supporting materials to Cascade Pacific RC&D at the address below.
 Application and budget must be submitted in the same software format provided (NOT PDF).
 Photos and maps must be titled, and must be submitted in files separate from the application.
 Applications must be postmarked on or before September 2, 2014.
No faxed or e-mailed applications will be accepted.
Cascade Pacific RC&D
31978 North Lake Creek Drive
Tangent, OR 97389
For more information contact Cascade Pacific RC&D at (541) 248-3094
Or e-mail: Kirk Shimeall, stewardship@cascadepacific.org
Page 0
2014 Coast Range Stewardship Fund Application
Section I
APPLICATION CONTACT INFORMATION
Type the information for Sections I and II USING ONLY the pages provided (or reproduce the pages on
your computer using the spacing and layout shown, NOT TO EXCEED 2 PAGES)
Name of project:
Coast Range Stewardship Dollars requested: $
Total cost of project: $
(Note: Amounts indicated should match with Section IV and V information)
Project location:
This project occurs at (check one):
Watershed(s)
A single site
Multiple sites
Stewardship Area
Township, Range, Section(s)
County or counties
Siuslaw
Alsea
Marys Peak
Hebo
Longitude, Latitude (if available)
Applicant and Technical Contact Information:
Official Applicant Contact:
Name
Organization
Street
City, State, Zip
E-mail
Phone
Fax
Project Manager (if different that official contact):
Name
Organization
Street
City, State, Zip
E-mail
Phone
Fax
USFS Technical Contacts:
Contact 1 Name
Title
Office Location
E-mail
Phone
Fax
Copy and paste additional USFS technical contact tables here if needed.
Landowners (if different than applicant):
Owner 1 Name
Street
City, State, Zip
E-mail
Phone
Fax
Copy and paste additional landowner tables here if needed.
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2014 Coast Range Stewardship Fund Application
Section II
PROJECT INFORMATION
1. Abstract. In approximately 200 words:
a) Identify the project location,
b) The watershed or landscape issue(s) to be addressed
c) The proposed solution, including the area or other measurable units to be treated
c) Any proposed effectiveness monitoring, inspection and
d) How Coast Range Stewardship funds will be used for on-the-ground-restoration.
2. Was this application submitted previously?
a) If yes, why is the project being resubmitted.?
b) What changes have been made to the project since last submission?
Yes
3. Is this project a continuation of a previously Coast Range Stewardship-funded project(s)?
No
Yes
No
If yes, what was the application(s) number?
4. Project Type and Metrics
(X)
Type of project - Checkmark (X) one or more
Measurement for
Restoration Evaluation, e.g,
Est. # acres, mi, etc.
Riparian planting, fencing, protection, and release of seedlings
Aquatic structures, in-stream structures to improve aquatic habitat
Culverts repair or replacement for fish passage or sediment reduction
Wetland restoration, tidal and fresh water
Noxious weeds eradication or control
Water quality improvements, or Storm water drainage
Wildlife habitat improvement, foraging/meadows improvement, snag
creation
Thinning, non-commercial stand improvement, non-commercial riparian
conversion
Road drainage, road decommissioning
5. Funding Overview: Have any conditions been placed on other funds that may affect project completion?
Yes
No
If yes, explain:
6. Explain how your project benefits the lands and resources administered by the Siuslaw National Forest.
(Refer to consultation with technical specialist and answers to the threshold questions.)
Attachments — Complete and attach to the back of your application:
Project Maps: 1) Provide a vicinity map showing township, range, and section (TRS), and the project
location. 2) On a USGS 7.5 min. topo quad map, or on an aerial photo showing TRS, locate the extent of your
project and site-specific activities. Provide maps on 8½ x 11 pages and include a legend.
IMPORTANT: Map must show project site’s proximity to National Forest Land Boundary
Preliminary Project Designs: Provide sufficient detail to allow a reasonable evaluation of the proposal and of
the effect of the project on the site. The preliminary design should include reference to appropriate standards and
guidelines.
Photographs: Provide pre-photographs to aid in understanding the situation. Note: If your project is
funded, pre-project photos will be required in the final report.
NEW: Technical Specialist Consultation and Threshold Question Review Form
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2014 Coast Range Stewardship Fund Application
Section III
SPECIFIC RESTORATION PROJECT ACTIVITY
R1.
Contextual Overview (0-10 points) Do not describe the project here; you will do so in
question #R3
Is the project a portion of a larger project effort in the watershed?
Yes
No
Is this a request for multiple years of funding or a single project year?
Single year
Multiple Years
Provide the location and significance of the project including why that location was chosen and a brief
explanation of the history of the issues leading to the project. Describe the project in the context of the
landscape including the key water quality, water quantity, species, habitat, land use and resource
management issues (physical or social) that are proposed to be addressed in that watershed.
R2.
Problems to Be Addressed (0-10 points)
Use the table below to provide site-specific information for the project: a) The specific problem(s) you
are addressing; and b) the root cause(s) of the problem(s). Do not describe the project here; you will do
so in question #R3.
Specific Problem(s)
Root Cause(s) of the Problem
Add rows as needed
R3. Project Description (0-15)
Using the table below, provide a description of the project that details the restoration activities to occur
(e.g., remove 36″ culvert, place 12 three log clusters between RM 44 and 52, etc.), including a
description of the methodologies (e.g., tree release – manual or herbicide; etc.) and the equipment planned
for use. In addition, describe any Project Management functions/activities necessary to implement the
project (e.g., acquire permits* or landowner approval; solicit bids, award contracts, etc.). The degree of
detail should match the project complexity and technical difficulty to allow for full evaluation of technical
viability. For projects involving multiple sites, be sure to identify and describe them separately, and
indicate their locations on maps, as appropriate. You may add narrative in addition to the table.
Project Element
Restoration Activity
Proposed Action
Add rows as needed
Project Management
Activity
Add rows as needed
R4. Project Objectives
(0-10 points)
What are the proposed project objectives? Provide specific objectives based on the location, size and
significance of the project and provide information on how the objectives can be evaluated. The
measurements should be able to be used to document successful implementation.
Project Element
Specific Objectives
Measure for Evaluation
Add rows as needed
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2014 Coast Range Stewardship Fund Application
R5. Project Design (0-15 points)
a) Provide a list of qualifications and experience you will require for the project designer. If a project
design has been completed, identify the designer and what qualifications and experience they have
(include CV, if a design firm, the credentials of key members, similar projects designed.)
b) Describe the design criteria used or proposed and how those criteria take into consideration natural
events and conditions (e.g., culvert design to 100-year flood event, wood placement to readjust with
higher than bank-full flows, cultivation to retain at least 75% stubble, 4-strand fence to allow for
wildlife passage, etc.).
c) Were alternative designs or solutions considered? (check one)
Yes
No
If yes, explain why the design or approach proposed was chosen. If no, explain why alternative
approaches were not explored.
R6.
Permits or Licenses required to implement Project: (0 points)
List each component or activity of the project that requires a permit(s) and/or license(s) from a
local, state or federal agency or governing body. Use the table provided to list the activities and permit(s)/license(s) including the entity issuing the permit(s)/license(s). In Column 1 and in separate rows, list
the project activities requiring a permit or license. In Column 2, provide the name of the permit or license.
In Column 3, provide the name of the entity issuing the permit or license.
Project Activity Requiring a
Permit/License*
Permit or License Name
Entity Issuing Permit or License
Add rows as needed
*Permits must be paid from match funding sources.
R7.
Work Plan Payment Schedule. (0-10 points)
Using Line Items from your budget, create a schedule of when tasks will be completed, and funds will be
needed for these tasks. Where possible, try to lump together activities that will be happening within the same
30-60 day period. Add rows as needed
Project Stage and Phases
Example:
Pre-Implementation
Implementation
Post Implementation
Add rows as needed
(remove examples)
Description of Activities
 Purchase plants, landowner
coordination project
management
 Tree Planting Staking,
release, project mgmt
 Inspection, release, replant
report, project management
 Project completion
Date
AMOUNT of
FUNDS NEEDED
 11/30/12
$14, 300
 4/30/12
$7,200
 9/30/12
$4,400
 10/30/12
Total
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2014 Coast Range Stewardship Fund Application
R8.
Project Implementation Inspection (0-10 points)
Identify who will inspect and sign off on the completed project. Use the table below to indicate who will
inspect and sig off on the completed project, as well as submit the Project Final Report.
Agency/Organization
Telephone
Number
Email Address
Project Element Inspected
Add rows as needed
R9.
Project Maintenance and Inspection Reports (0-10 points)
Use the table below to document how the project will be maintained over time. State who will maintain the
project. Identify their affiliation and provide contact information. In addition, please indicate who will
conduct Post-Implementation Status Reporting following project (if applicable) Identify and provide contact
information for that organization
Name of Person
Agency/Organization
and Addresses
Telephone Number
E-mail Address
What will be done and for how long?
Add rows as needed
R10. Budget Development Questions for Section IV Coast Range Stewardship Budget (0-10
points)
There are a number of assumptions used to develop any budget. This does not mean you must provide a line
by line description of costs. Simply provide a clear understanding of what the budget estimate was based on.
a) Explain how costs were determined for the budget elements. Describe if contractor conversations, past
projects or other cost figures were used for each major element of the budget. This is particularly important for lump sum elements in the budget. For project management costs describe the time and activities that would be involved.
b) If there are any unusual cost factors, explain them. For example, if the fencing costs are unusually high
because of steep, rocky terrain and non-road access, this is the place to explain the cost elements on the
budget page.
R11.
Educational/Public Awareness Opportunities (0 points)
Explain whether and how you will educate and raise public awareness about the project (e.g., install a
project partner sign, write an article for the local paper, lead a site tour for local citizens). NOTE: Funds
for education and outreach costs are ineligible for Coast Range Stewardship Funds, and must come from
your matching source.
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2014 Coast Range Stewardship Fund Application
Section IV
STEWARDSHIP FUND PROJECT BUDGET
Use 2014 Stewardship Fund Budget Form (excel) found at:
http://www.cascadepacificstewardship.org/multilist_42/stewardship-fund/stewardship-fund
If possible, fit the budget on one page by removing unneeded rows (leave subtotal rows in place).
.
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2014 Coast Range Stewardship Fund Application
Section V
MATCH FUNDING FORM
Document match funding shown in your budget
Coast Range Stewardship accepts all non-USFS funds as match. An applicant may not use another USFS
Stewardship grant to match a Coast Range Stewardship grant.
At the time of application, match funding does not have to be secured, but you must show that at least 25% of match
funding has been sought. On this form, you do not necessarily need to show authorized signatures (“secured match”),
but the more match that is secured, the stronger the application. Identify the type of match (cash or in-kind), the status of
the match (secured or pending), and either a dollar amount or a dollar value (based on local market rates) of the in-kind
contribution.
If you have questions about whether your proposed match is eligible or not, contact Cascade Pacific RC&D or your
USFS Technical contact).
Project Name:
Match Funding Source
Applicant: ___________________________________
Type
(√ one)
Status
(√ one)*
Dollar
Value
cash
in kind
secured
pending
$_________
cash
in kind
secured
pending
$_________
cash
in kind
secured
pending
$_________
cash
in kind
secured
pending
$_________
cash
in kind
secured
pending
$_________
cash
in kind
secured
pending
$_________
cash
in kind
secured
pending
$_________
Match Funding Source
Signature/Date*
IMPORTANT: If you checked the “Secured” box in the status Column for any match funding source, you must provide either the signature of an authorized representative of the match source in the final Column, or attach a letter of support from the match funding source that specifically mentions the dollar amount you show in the Dollar Value Column.
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2014 Coast Range Stewardship Fund Application
Section VI
LAND USE INFORMATION FORM
This information is needed to determine if the proposed project complies with statewide planning goals and is
compatible with local comprehensive plans (ORS 197.180). The form must be submitted before Cascade Pacific
RC&D releases project funds. Cascade Pacific RC&D will release project funds only if the project either is not
regulated by, or is compatible with, the local comprehensive plan and zoning ordinance. If a project is regulated
by the local comprehensive plan and zoning ordinance, Cascade Pacific RC&D 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 for a project regulated by the local comprehensive plan and zoning ordinance, Cascade Pacific RC&D will not release project funds until these conditions are satisfied.
1. TO BE COMPLETED BY THE APPLICANT/GRANTEE
Applicant/Grantee Name: _____________________________________________________
Project Name: ______________________________________________________________
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
______ Plan Amendment
______ Other
______ Development Permit
______ Zone Change
An application has ___ has not ___ been made for the local approvals checked above.
* Signature of Local Official
Date
Print Name:
Phone:
Title:
E-mail:
*Signature is not required before application is submitted; however signatures are required before project
contract is executed. Must be an authorized signature from your local City/County or Tribal Planning
Department, regardless of which box is checked above.
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2014 Coast Range Stewardship Fund Application
Section VII
LANDOWNER/APPLICANT CERTIFICATION
Monitoring Information from Participating Private Lands
is Public Record
All applications that involve physical changes or monitoring on private land must include a landowner signature
signifying their approval and understanding that all monitoring information obtained on their property is public record. An explanation must accompany the application if any of the information required on the application cannot be
provided. The landowner’s signature will be required prior to the release of the grant agreement if the application is
approved for funding.
Therefore, EITHER the applicant must sign and date in the “For the Applicant” section below, OR all private landowners participating in the project must complete this form at the application stage (use additional
pages, if necessary) by signing in the “For the Landowner(s)” section below.
The project will occur on (check one):
Public land only (STOP: No need to complete the rest of the form)
Private land only
Public & private land (If you check either of these boxes, complete either of the boxes below)
EITHER
For the Applicant: I am unable to secure all landowner signatures at this time as not all landowners have been
identified at the time of application. I understand that should Cascade Pacific RC&D fund this project, that I am required to secure all participating landowner signatures prior to the release of a Cascade Pacific Forest Stewardship
Initiative agreement for this project.
Applicant Signature
Date
OR
For the Landowner(s): By my signature below, I certify my understanding and approval that should Cascade Pacific RC&D fund part, or all, of this Application, that all monitoring information obtained on my property as a result of
this project is public record. I understand that if I refuse to comply with the terms of this form, I will jeopardize my
ability to receive Coast Range Stewardship Fund compensation for my participation in this project.
Landowner Signature
Print Name:
Date
Landowner Signature
Print Name:
Date
Landowner Signature
Print Name:
Date
Landowner Signature
Print Name:
Date
Landowner Signature
Print Name:
Date
Landowner Signature
Print Name:
Date
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2014 Coast Range Stewardship Fund Application
Section VIII
LEGAL REQUIREMENTS FORM
AGREEMENTS:
I/we,_________________________________________________________________________
_________
of ______________________________________, Oregon, hereby make application for
financial assistance under the terms and conditions of the Cascade Pacific Forest Stewardship
Initiative in the amount of $______________. The total cost of the project is $______________,
as shown in Section I of the application and on the budget page.
I/we understand that if this project is funded, I/we will in most cases be required to:

Sign a Grant Agreement containing the terms and conditions upon which funds will be
released (work on the grant may not begin until all parties have signed the Grant Agreement);

Submit a Cooperative Agreement between the Project Sponsor (Grantee) and the
Landowner(s) addressing issues of site access, monitoring, and maintenance;

Certify that the project complies with state, federal, and local regulations;

Submit copies of all applicable permits and licenses from local, state, or federal agencies or
governing bodies, or written evidence that permits and licenses are not needed;

Submit a report at the completion of the project, and subsequent periodic reports as required
in the Grant Agreement, on the project’s performance;

Resolve any and all outstanding issues from previous grants with Siuslaw Stewardship
Funds.

Agree that educational products and monitoring information resulting from projects are
public domain;

Complete the Oregon Watershed Restoration Reporting Form*

Certify that the work to be accomplished will comply with the USFS Stewardship Criteria.
Signed: ___________________________________ Date:
Print Name:
Title:
Page 10
2014 Coast Range Stewardship Fund Application
APPLICATION CHECKLIST
Instructions: Please cross-check to ensure that your application is complete. An incomplete application will
jeopardize your application’s review.
General
 USFS Technical Specialist Wyden Funding Pre-Application Review Form submitted & approved
 Submit one hardcopy and one digital copy (CD) of the Application postmarked no later than






September 2, 2014
Photos are separated from the application document
The application and attachments are submitted in the same software format as provided (not PDF)
The application and attachments are single-sided and single-spaced and on 8 ½ x 11″ paper
The application and attachments are not stapled or bound
Where color photos or color maps are provided, include 1 hardcopy and one digital copy of each.
Photos and maps have numbers and titles referenced in question R3 of application
Section I – Applicant Information
 All questions in this section have been answered
 The Stewardship Funds requested and the total project cost mirror the totals shown on the Budget
 The project location is complete
 All contact information — for the applicant and the USFS Technical Contact is complete and current
Section II – Project Information
 All questions in this section have been answered
Section III – Specific Restoration Project Activity
 All questions in this section have been answered
Section IV - Budget Page
 All application instructions for completing the budget page have been answered
 Columns A and B have been completed, where appropriate
 The totals shown in the last row add up and are accurately reflected in Section I of the application
Section V - Match Funding form – show the amount of match that has been sought (authorized
signatures are not required at the application stage, but are strongly encouraged)
Section VI, Section VII and Section VIII - Required Forms
Section VI - Land Use form (required only for applications involving on-the-ground activities to ensure
compatibility with the local comprehensive plans and zoning ordinances) — completed as relevant,
signed, and dated by local official
 Section VII - Landowner/Applicant Certification form – completed, signed, and dated by all participating landowners (this must happen before award is contracted)
 Section VIII - Legal Requirements form – completed, signed, and dated by the applicant
Attachments – All referenced photos, maps, designs and letters are included in this packet (see page 2 of the
application for details)
 Project Maps
 Photographs
 Preliminary Project Designs, CVs, and supporting documents
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2014 Coast Range Stewardship Fund Application