**1. Project Number** (Assigned by federal unit):[     ]{.underline}

  --------------------------------------------- -------------------------
  **2. Project Name:**                          **3. County:**

  **4. Project Sponsor:**                       **5. Date:**

  **6. Sponsor's Phone Number:**                

  **7. Sponsors E-mail**:                       
  --------------------------------------------- -------------------------

  ------------------------------- ---------------------------------------
  **8. Project Location** (attach 
  project area map**)**           

  a\. 4^th^ Field Watershed Name  
  and HUC #(if known              

  b\. 5^th^ Field Watershed Name  
  and HUC #(if known              

  c\. Legal Location: Township    
  Range Section(s)                

  d\. BLM District Salem District e\. BLM Resource Area
  Office                          

  f\. National Forest             g\. Forest Service District      

  h\. State / Private / Other     
  lands involved? Yes No          
  ------------------------------- ---------------------------------------

  -----------------------------------------------------------------------
  **9. Statement of Project Goals and Objectives:**

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **10. Project Description:** (Provide concise description of project
  and attach map.)

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **11. Coordination of this project with other related project(s) on
  adjacent lands?**

  Yes No **If yes, then describe**
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  **12. How does proposed project meet purposes of the Legislation?**
  \[Sec. 203(b)(1)\]

  Improves maintenance of existing infrastructure. \[Sec. 2(b)\]

  Implements stewardship objectives that enhance forest ecosystems.
  \[Sec. 2(b)\]

  Restores and improves land health. \[Sec. 2(b)\]

  Restores water quality. \[Sec. 2(b)\]
  -----------------------------------------------------------------------

  ----------------------------------- -----------------------------------
  **13. Project Type** (check one)    
  \[Sec. 203(b)(1)\]                  

  Road Maintenance \[Sec.             Trail Maintenance \[Sec.
  2(b)(2)(A)\]                        2(b)(2)(A)\]

  Road Decommission/Obliteration      Trail Obliteration \[Sec.
  \[Sec. 2(b)(2)(A)\]                 2(b)(2)(A)\]

  Other Infrastructure Maintenance    
  (specify): \[Sec. 2(b)(2)(A)\]      
                                      

  Soil Productivity Improvement       Forest Health Improvement \[Sec.
  \[Sec. 2(b)(2)(B)\]                 2(b)(2)(C)\]

  Watershed Restoration & Mntc.       Wildlife Habitat Restoration \[Sec.
  \[Sec. 2(b)(2)(D)\]                 2(b)(2)(E)\]

  Fish Habitat Restoration \[Sec.     Control of Noxious Weeds \[Sec.
  2(b)(2)(E)\]                        2(b)(2)(F)\]

  Reestablish Native Species \[Sec.   
  2(b)(2)(G)\]                        

  Other Project Type (specify) \[Sec. 
  2(b)(2)\]:                          
  ----------------------------------- -----------------------------------

  ----------------------------------- -----------------------------------
  **14. Measure of Project            
  Accomplishments/Expected Outcomes** 
  \[Sec. 203(b)(5)\]                  

  a\. Total Acres:                    b\. Total Miles:

  c\. No. Structures:                 d\. Est. People Reached

  e\. No. Laborer Days:               

  f\. Other (specify):                
  ----------------------------------- -----------------------------------

**15. Duration of Project and Estimated Completion Date:** \[Sec.
203(b)(2)\]

**16. Target Species Benefited:** (if applicable)     

**17. How will cooperative relationships among people that use federal
lands be improved?** \[Sec. 2(b)(3)\]

**18. How is this project in the best public interest?** \[Sec.
203(b)(7)\] **Identify benefits to communities.**

**19. How does project benefit federal lands/resources?**

.

  --------------------------------------- --------- -------- -------------
  **20. Status of Project Planning**                         

  a\. NEPA Complete:                      Yes       No       

  If no, give est. date of completion:                       
                                                             

  c\. ESA Consultation Complete:          Yes       No       Not
                                                             Applicable

  d\. ESA Consultation Complete:          Yes       No       Not
                                                             Applicable

  e\. Survey & Manage Complete:           Yes       No       Not
                                                             Applicable

  f\. Permits for In-stream Work          Yes       No       Not
  Obtained:                                                  Applicable

  g\. Fill/Removal Permit Obtained:       Yes       No       Not
                                                             Applicable

  h\. Concurrence Received:               Yes       No       Not
                                                             Applicable

  i\. Project Design(s) Completed:        Yes       No       

                                                             
  --------------------------------------- --------- -------- -------------

  ----------------------------------- -----------------------------------
  **21. Proposed Method(s) of         
  Accomplishment**                    

  Contract                            Federal Workforce

  County Workforce                    Volunteers

  Other (specify):                    
  ----------------------------------- -----------------------------------

**22. Will the Project Generate Merchantable Materials?** \[Sec.
204(e)(3)\]

Yes No

  ----------------------------------- -----------------------------------
  **23. Anticipated Project Costs**   
  \[Sec. 203(b)(3)\]                  

  a\. Total County Title II Funds     
  Requested: .                        

  b\. Is this a multi-year funding    
  request? Yes No \* If yes, then     
  display by fiscal year              

  c\. FY02 Request:                   f\. FY06 Request:      

  d\. FY03 Request:                   g\. FY07 Request:      

  e\. FY04 Request:                   h\. FY08 Request:      

  f\. FY05 Request:                   i\. FY09 Request :      
  ----------------------------------- -----------------------------------

# Table 1. Project Cost Analysis

+-------------------------+-----------+-----------+-----------+-------+
| **Item**                | *Column   | *Column   | *Column   | *C    |
|                         | A*        | B*        | C*        | olumn |
|                         |           |           |           | D*    |
|                         | **Fed.    | **Re      | **Other** |       |
|                         | Agency**  | quested** |           | **To  |
|                         |           |           | **Contri  | tal** |
|                         | **Appro   | **County  | butions** |       |
|                         | priated** | Title     |           | **A   |
|                         |           | II**      | **\[Sec.  | vaila |
|                         | **Contr   |           | 203(      | ble** |
|                         | ibution** | **Contr   | b)(4)\]** |       |
|                         |           | ibution** |           | **Fu  |
|                         | **\[Sec.  |           |           | nds** |
|                         | 203(      | **\[Sec.  |           |       |
|                         | b)(4)\]** | 203(      |           |       |
|                         |           | b)(4)\]** |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 24\. Field Work & Site  |           |           |           |       |
| Surveys                 |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 25\. NEPA & Sec. 7 ESA  |           |           |           |       |
| Consultation            |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 26\. Permit Acquisition |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 27\. Project Design &   |           |           |           |       |
| Engineering             |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 28\. Contract           |           |           |           |       |
| Preparation             |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 29\. Contract           |           |           |           |       |
| Administration          |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 30\. Contract Cost      |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 31\. Workforce Cost     |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 32\. Materials &        |           |           |           |       |
| Supplies                |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 33\. Monitoring         |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 34\. Other              |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 35\. Project Sub-Total  |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| 36\. Indirect Costs     |           |           |           |       |
| (Overhead)              |           |           |           |       |
|                         |           |           |           |       |
| (per year for           |           |           |           |       |
| multi-year projects)    |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+
| **37. Total Cost        |           |           |           |       |
| Estimate**              |           |           |           |       |
+-------------------------+-----------+-----------+-----------+-------+

**38. Identify Source(s) of Other Funding for Project Identified Above**
\[Sec. 203(b)(4)\]

**39. Monitoring Plan** \[Sec. 203(b)(6)\]

a.  **What measures or evaluations will be made to determine how well
    the proposed project meets the desired ecological conditions?**
    \[Sec. 203(b)(6)\] **Who will be responsible for this monitoring
    item?**

b.  **How will the project be evaluated to determine how well the
    proposed project contributes towards local employment and/or
    training opportunities, including summer youth jobs programs such as
    the Youth Conservation Corps?** \[Sec. 203(b)(6)\] **Who will be
    responsible for this monitoring item?**

c.  **What methods and measures of evaluation will be established to
    determine how well the proposed project improves the use of, or
    added value to, any products removed from federal lands consistent
    with the purposes of this Act?** \[Sec. 203(b)(6) and Sec.
    204(e)(3)\] **Who will be responsible for this monitoring item?**

d.  **Identify total funding needed to carry out specified monitoring
    tasks (Table 1, item 33)**