shooting range grant app

7/28/2019 Shooting Range Grant App

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DEC Shooting Range Small Grants Program

New Y ork State Department ofEnvironmental Conservation

APPLICATION PACKET CHECKL IST

A completed Application Check List must be attached to the Cover Page. Copy or remove thispage, then check each item you have attached to your application. Incomplete applications are

ineligible for funding.

Check to indicate item is in your application packet

Application Cover PageApplication Check ListProject Proposal must include the following:

Project Need Project Objective Project Approach Special Benefits Public Benefit Information Population Dynamics Project Guideline References Educational Instruction Project Budget (include budget worksheet page that is in this application packet)

Supporting Documentation must include the following: Organization Information Current Facility Qualifications Non-Profit Status and Proof of Ownership Insurance Certificate Location Map Site Plan Environmental Stewardship Plan (Lead Reclamation) Range Strategic Plan Range Safety Plan Board Resolution (included in this application packet)

Submit three complete sets of the application and support documentation(one set being the original)Mail to: NY SDEC, Melissa Bailey, 207 Genesee St 14th Floor, Utica, NY 13501

All documentation must be received by close of business on May 31, 2013(refer to page 5 of theGrant Program Guidelines for more detailed information)


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Application Cover Page

Fill out and print this page and use as cover page for project proposal and required supporting documentation.

DEC Shooting Range Small Grants Program Department Use OnlyApplication #Date Received:Grant Year- 2013

Applicant (Organization orMunicipality)Project Title

Total Project Cost $Grant award is 75% of total project cost with amaximum award being $15,000.Total Grant Amount Requesting $

Brief Description of the ProjectExpected Project Start Date Expected Project End Date

Name of Project Coordinator

Mailing Address

Telephone Fax Number

Email Address

Range InformationWebsite of Club or Range

Mailing Address of Rangeor General Range LocationLegal Description Tax parcel # Town County

Secondary Contact InformationAdditional Contact and

TitlePhone Number

Email Address ofAdditional Contact

By signing below, I certify that the information contained in this grant application is accurate. If awarded a grant, ourorganization will abide by the requirements of the DEC and CCE and that failure to meet the requirements of the grantprogram will result in not being reimbursed.

Signature of Project Coordinator Date

Printed Name of Individual Above


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PROJ ECT PROPOSAL

The project proposal must be atyped document that describes the project and is limited to threepages of single-spaced text (additional pages of pictures or supporting documentation and plansshould be attached, not included in the three page limit). A page is defined as one side of an8.5 inch by 11 inch sheet of paper.

Attach the project proposal report to this page. The project proposal should include:(refer to page 6 and 7 of theGrant Program Guidelines for a more detailed description)

a. Project Need

b.Project Objective

c. Project Approach

d. Special Benefits

e. Public Benefit Information

f. Population Dynamics

g. Project Guideline References

h. Educational Instruction

i. Project Budget (Budget Worksheet is included in this application packet)


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BUDGET WORKSHEET

Use this worksheet to develop a cost estimate. Additional categories may be used if needed.

Applicant (Organization orMunicipality)

Department Use OnlyApplication #

Project Title

Estimated Costs

Applicant Dollars(Cash DollarsDedicated to theProject)

Value of DonatedServices andSupplies

This column shouldcontain estimates ofall project costs

Applicant dollars, donated services and/or suppliesmust be at least 25% of the project cost.

Planning/Development$____________ $____________ $____________

Equipment$____________ $____________ $____________

Construction(Contractor etc) $____________ $____________ $____________

Labor$____________ $____________ $____________

Supplies$____________ $____________ $____________

Other$____________ $____________ $____________

Total Project Cost$____________

Combine above amounts andput total in box below.

Combine above amountsand put total in box below.

Total OrganizationalDollars and Donations(Must equal or exceed 25% of thetotal project cost.)

$____________=

$____________ +

$____________

Grant Request(Grant award is 75% of totalproject cost with a maximumpossible award being $15,000)

$____________

Please tell us if any other organizations are providing funding for this project:


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SUPPORTING DOCUMENTATION

Required additional information (not covered under the three page Project Proposal limit) thatapplicants must submit.

Attach the supporting documentation to this page. The supporting documentation should include:(refer to page 7 and 8 of theGrant Program Guidelines for a more detailed description)

a. Organization Information

b. Current Facility

c. Qualifications

d. Non-Profit Status and Proof of Ownership

e. Insurance Certificate

f. Location Map

g. Site Plan

h. Environmental Stewardship Plan (Lead Reclamation)

i. Range Strategic Plan

j. Range Safety Plan

k. Board Resolution (is included in this application packet)


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BOARD RESOLUTION

Board resolution in support of the DEC Shooting Range Small Grants Program applicationEach application must include this resolution, signed by the president or similar governing groupor officer, indicating that the application has the approval of the organizations governing board.

This resolution form must be attested to by the organizations secretary or officer

Resolution of governing body: ________________________________ agrees to the following:(Applicant Name)

Authorizes the Project Coordinator listed on the Cover Page to act on behalf of thisorganization by conducting negotiations, and by executing and submitting documents,

including but not limited to, applications, agreements, amendments, and other documents

which may be necessary for the completion of the project; Approves the filing of an application for a shooting range mini grant; and Certifies that the project application is consistent and compatible with all adopted plans and

programs for safe shooting range development; and Agrees to comply with all procedures, guidelines and requirements of the DEC as a part of

the application process; and Understands that the project scope and funding amount are subject to final approval by the

Shooting Range Small Grants Program Scoring Committee; and

By signing below, I certify that I am the duly appointed and qualified ___________________(Office Title)

of the __________________________________ and certify that the foregoing resolution is true,(Applicant Name)correct and was passed and adopted at a regular meeting of the board or similar governing group,held on _______________________ at which the minimum required number of representatives

(Date)

to transact business were present.

Signature of Office Holder Date

Printed Name and Title ofIndividual Above

Signature of Secretary or AnotherOfficer Holder

Date

Printed Name and Title ofIndividual Above

shooting range grant app

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