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PART I

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					        FOREST LEGACY PROGRAM (FLP) PROPOSAL FORM
                 Submittal Date: _____________
 Note: Please refer to the instructions to ensure correct completion of this form.

PART I – TESTIMONY AND SIGNATURE



The information in this proposal is true to the best of my knowledge and belief. I (we), as the
landowner(s) or landowner’s authorized agent (proof of authorization must accompany the
proposal) agree to allow inspection, appraisal, and survey of the property being offered for
consideration under Alaska’s Forest Legacy Program. I agree to allow members of the Alaska
Department of Natural Resources, Federal Forest Legacy Program, Alaska’s Forest Stewardship
Coordinating Committee, or their designated staff to inspect the property at any mutually
agreeable time for the purposes of this proposal. I understand I shall be notified in advance of all
inspection visits.

I also understand that this property/easement will not be purchased if negotiations do not reach
an amicable agreement or if the property does not meet the needs or qualifications of the Alaska
Forest Legacy Program. The property will only be purchased from willing sellers.

I also understand that all submitted materials become property of the State of Alaska and are
non-returnable. Disclosure of requested information is voluntary. However, failure to provide all
of the requested information may make it difficult for your nomination of the property to be
properly evaluated and scored.


Signature(s) of landowner(s) or legal agent                  Date


        __________________________________                __________
        Print Name:


        __________________________________                __________
        Print Name:


        __________________________________                __________
        Print Name:




FLP Project Proposal Form 4/09
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PART II – PROJECT NOMINATION
1) Proposal submitted by:

     Contact person:
     Organization, if applicable
     Address:
     City, State, Zipcode:
     Email Address:
     Daytime Phone:
     Fax:

2) Owner(s) of the property (or any others with interest in the property):

     Landowner’s name:
     Address:
     City, State, Zipcode:
     Phone:
     Email Address:
     Fax:

3) Proof of the landowner’s authorized agent is provided in an Appendix A. Yes ___
    Not applicable _____


PART III – PROPERTY INFORMATION
1)    Name of the property:

2)    Is the property located in an area defined in Alaska’s Assessment of Need?
      Yes ____ No ____

3)    What is the general location of the property?

4)    Legal description (Section, Township and Range):

5)    What is the total value of the property?

6)    What is the valuation based on?

      If appraised, what is the date of the appraisal?

7)    Are there any encumbrances on the property? Yes ____ No ____. If yes, please list and
      explain.

8)    Describe ownership of subsurface or mineral estate.

9)    Is there legal access to the property? Yes ____ No ____

10) Describe any structures on the property and the acreage these structures occupy:

11) Has there ever been activity on the property that would have left hazardous material or
    waste that the owner will need to clean up before the property is purchased?

12) How many tracts are in the proposed project?


FLP Project Proposal Form 4/09
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13) What is the total acreage of all of the proposed tracts?

14) Is this a phased project? If yes, please explain.

      Can the current proposal be phased?

If the proposed project is a Fee Simple (FS) Acquisition, answer the following questions for
each tract:

15) What government entity will hold the title?

16) Is there documentation from this government entity that it will hold title? Yes ____ No ____

17) Documentation is included as an Appendix B. Yes ____ No ____


If the proposed project includes a Conservation Easement (CE), answer the following questions
for each tract:

18) Has a Forest Stewardship Plan or multi-resource management plan been developed and
    approved by the landowner and State Forester or designee?
    Yes ____ No ____

19) Is the land owner willing to manage the property according to an approved Forest
    Stewardship Plan or multi-resource management plan? Yes ____ No ____

20) Documentation is included in Appendix C. Yes ____ No ____

21) What government entity has agreed to manage the conservation easement and monitor the
    property in perpetuity to ensure consistency with Forest Legacy Program requirements?

22) Is there documentation to substantiate this agreement? Yes ____ No ____

23) Documentation is included in Appendix C. Yes ____ No ____


24)   Please identify all discreet tracts (parcels) in the following Tract chart:


                          Type of            # of        # of Open or    # of Acres of    Total Acres in
Tract Name               Purchase         Forested         Cleared       Water in the       the Tract
                        (FS or CE)       Acres in the    Acres in the        Tract
                                            Tract            Tract




  Total Number of Acres




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     PART IV – PROJECT FINANCIAL INFORMATION

           1) Projected funding chart:


Year of        Name of Each        FLP Federal      Non- Federal         Other           Total           Total
Funding        Project Phase       Request ($)        Match ($)         Project         Project         Project
                                  Maximum 75%       Minimum 25%        Funding         Costs ($)        Acres
                                                                      Sources ($)

FFY 2011
FFY 2012
FFY 2013
 Totals

           2) Letters documenting matching contributions are included in an Appendix D:
              Yes __ No __



     Note: The Forest Legacy Program, at the national level, evaluates all proposals based
     on an online project proposal submittal. The yellow highlighted portions of this
     application identify the requirements of the on-line submittal. It is critical that the
     information contained in these sections of the application put the project in a context
     easily understood by those who are unfamiliar with Alaska. If you wish to provide a more
     detailed project description and narrative, you may do so in addition to the information
     requested below, consistent with the proposal instructions.

     PART V – PROJECT DESCRIPTION

       The project description may contain no more than 1100 characters. (10 point font):
       If you wish to include a more detailed descriptioin for Alaska’s Forest Stewardship Committe‘s
       consideration you may do so (3 page max). Please note however, that if your project is
       selected for the National competition, the narrative MUST be distilled to no more than 1100
       characters.




     FLP Project Proposal Form 4/09
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PART VI – BOLSTERING ALASKA’S ASSESSMENT OF NEED
    1) Timber Protection and Management Opportunity:

    2) Habitat Protection:

    3) Recreation Opportunities:

    4) Buffering, Protection and Enhancement of Conservation System Units:

    5) Forest Fragmentation:

    6) Importance to Alaska’s Communities:

    7) Protection of River Systems, Wetlands, Coastal Areas:


PART VII – FLP CORE CRITERIA

Note: This section must be written as bullets. You may have any number of bullets in
each of the four criteria categories. Please note that this section of the proposal becomes
the content submitted for national consideration.
IMPORTANCE (255 characters or less)
Provide a minimum of five (5) bullets or points about the importance of the property. See
instructions for more information about limitations.

THREATENED (255 characters or less)
Provide a minimum of five (5) bullets or points to explain how the property is threatened to be
converted to non-forest use. See instructions for more information.

STRATEGIC (600 characters or less)

Provide a minimum of five (5) bullets or points to explain how the property is of strategic
importance to the state and nation. See instructions for more information.

READINESS (255 charaters or less)
Provide a minimum of five (5) bullets or points to explain how the property is ready for nomination
to Alaska’s Forest Legacy Program. See instructions for more information.


PART VIII – Supporting Parties
Letters from the following supporting organizations, partners, stakeholders are included in
Appendix E:


PART IX – MAPS AND PHOTOGRAPHS
Map(s) and color photograph(s) are included in an Appendix F: Yes ___ No ___




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      PART X – APPENDICES

      Checklist for Appendices:

Appendix A    Proof of landowner’s authorized agent.                      Yes    No    NA

Appendix B    If a fee simple acquisition, documentation of government    Yes    No    NA
              entity willing to hold title has been included for each
              tract.

Appendix C    If a conservation easement, documentation that a            Yes    No    NA
              landowner is willing to manage the property according to
              an approved Forest Stewardship Plan or multi-resource
              management plan.

Appendix C    If a conservation easement, documentation that a            Yes    No    NA
              government entity has agreed to manage the
              conservation easement and monitor the property to
              ensure consistency with FLP requirements.

Appendix D    Letters documenting matching contributions.                 Yes    No

Appendix E    Letters from supporting organizations, partners, and        Yes    No
              stakeholders.

Appendix F    Maps(s) and color photograph(s).                            Yes    No




      SPECIAL NOTE:        SEE INSTRUCTIONS FOR ELIGIBILITY, SCORING CRITERIA,
                           AND SUBMISSION OF PROPOSALS.




      FLP Project Proposal Form 4/09
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