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2002-2003 MINNESOTA ReLEAF <br />.. — COMMUNITtFOREST HEALTH PROGRAM..._.___._ __...Mw__ _ �_.__ <br />APPLICATION FORM <br />• Application is limited to this 4 -page form. Please refer to the Appiicatfon.Guidelines when <br />completing this form. Mall your completed and signed applicatipn to the DNR Regional contact In yourarea, see below. <br />Applications are due by 4:30pm Friday, June 14, 2002. A DNR Area Forester will be contacting you to complete a needs <br />assessment of your project. Grant recipients will be notified within 30 days. <br />Region.5 (South East): Ed Hayes, 2300 Silver Creek Rd. NE, Rochester, MN 55906, (507) 285.741 <br />Metro Region (Metro + former Region 3): Don Mueller, 1200 Warner Rd., St Paul, MN 55106, (651).772 -'6148 <br />This form is available via email from Sharon Schmitz, sharon.schmitzna,dnr.state,mn.us , (651) 297.7298. <br />1. Project Location <br />City, Township or County i <br />. l <br />2. Applicant Contact information <br />Applicant Organization Name: <br />Contact Person: ni4.&Uy //S'' <br />Mailing Address: <br />City, State, Zip code: k teJc 1.1.1<e'.S� j� A) . ,S;S b 1 ' <br />IP Project Technical Advisor: IA !t+ fvt,9 <br />(If different from Contact Person) • <br />t( %Lcuo )if-k?S <br />L <br />3. Applicant Eligibility (check one) <br />...municipality Township _County School District <br />Non- profit Organization (with 501(c)(3) status) <br />_Other (specify): <br />4. Project Budget Summary <br />• a. Non -state cash contributions: <br />b. Non -state in -kind contributions: <br />c. Mn ReLEAF Funding Requested:,' <br />TOTAL PROJECT COST (a+, b +c): <br />5. Project Schedule (approximate) <br />Start up date: <br />6. Project Summary Statement <br />• <br />• <br />• <br />$ S 30 , 9r% of total* <br />$ / 0 0 -0 - fd. • % of total <br />5 k6 6p• M %) of total <br />$_.x:21"/ C'3 <br />Completion date: <br />Phone No: (6s'() Q k Z Z V5,r-' <br />E- mail: ►Y$S SohPe<:Lrhx►-- L,Kesd//4 ttj- <br />Phone No: (on ) 5'9 e - Z y3� <br />E -mail: S-43-07 &J g6dve <br />• <br />•� <br />1 <br />