New Mexico Recycling and Illegal Dumping Alliance s1

NEW MEXICO RECYCLING AND ILLEGAL ILLEGAL DUMPING DUMPING ALLIANCE GRANT APPLICATION FORM

GRANT SUBMITTAL CHECKLIST DIRECTIONS: All applicants must complete and include this “Grant Submittal Checklist” with your application.

ORGANIZATION

PROJECT TITLE

DOCUMENT SUBMITTAL REQUIREMENTS CHECKLIST ATTACHED  DOCUMENT YES NO PART A: Illegal Dumping grant application form OR Recycling grant application form

Attach a photograph of the illegal dumpsite if your project is for a specific site

PART B. Certification signed by authorized agent

PART C. Budget proposal PART D. Community recycling and illegal dumping plan (In 2009, the plan is a mandatory component of the application) (Note: applicants can submit their existing plan or if they do not have a plan, use the sample format to prepare one) Please submit the above documents in order.

Incomplete grant submittals will not be considered.

ELIGIBILITY REQUIREMENTS CHECKLIST CHECK ONE  ELIGIBILITY REQUIREMENT YES NO

Is your organization a municipality, county, Indian nation, pueblo or tribe, land grant community, cooperative association or solid waste authority?

Have you checked to ensure that the project you are applying for is not on the “Types of items/projects that will not be funded” list on page ii, item 7, found in the Grant Instructions?

A no answer indicates that you or your project is not eligible for this grant NEW MEXICO RECYCLING AND ILLEGAL ILLEGAL DUMPING DUMPING ALLIANCE GRANT APPLICATION FORM

A. ILLEGAL DUMPING GRANT APPLICATION FORM

DATE

ORGANIZATION

CONTACT NAME

POSITION

STATE ADDRESS ZIP

EMAIL PHONE

PROJECT TITLE

TYPE OF ORGANIZATION (PLEASE CHECK )

MUNICIPALITY

COUNTY

INDIAN NATION, PUEBLO, OR TRIBE

LAND GRANT COMMUNITY

COOPERATIVE ASSOCIATION (SEE DEFINITION IN GRANT INSTRUCTIONS)

SOLID WASTE AUTHORITY

PROJECT TEAM

ROLE NAME ORGANIZATION PROJECT LEADER (GRANTEE REPRESENTATIVE)

TEAM MEMBERS

1. DESCRIPTION OF PROJECT (Includes a summary of the project and development of project work plan)

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Summary of the project DIRECTIONS: 100 word maximum Please respond to the following bullets to demonstrate their ability to meet this assessment criteria:  Clearly and briefly state what you want to do.  What do you intend to achieve?  Where do you intend to conduct the project?  How will your project eliminate or reduce in amount, degree, or intensity illegal dumping sites or prevent future illegal dumping? (Attach additional pages, if needed)

WILL SPECIFIC SITES BE REMEDIATED? Please check  Yes No

IF SPECIFIC SITES WILL BE REMEDIATED, YOU MUST ATTACH A PHOTOGRAPH OF THE DUMPSITE (S). Photograph of illegal dumpsite attached (please check ) Yes No

DESCRIPTION OF ILLEGAL DUMP SITE (IF APPLICABLE)

SITE ADDRESS OR LEGAL STATE DESCRIPTION OF LOCATION (TOWNSHIP/RANGE/SECTION) ZIP NAME OF OWNER

STATE

ADDRESS OF OWNER ZIP

EMAIL OF OWNER PHONE

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ESTIMATED VOLUME OF WASTE AT ILLEGAL DUMP SITE

TYPE OF WASTE AT DUMP SITE

WILL THE PROJECT INCREASE COMMUNITY PRIDE, AND IF SO HOW? For example: Will it foster regional cooperation, creation of new jobs, or increase land values due to improved services or reduced litter and dumpsites?

Project work plan DIRECTIONS: What actions will you take to achieve the stated goals? The quality of the work plan is not the number of actions, but the ability of your community to achieve them. How will you know if you have succeeded (performance measure)? How do your proposed budget items correspond with achieving each goal?

WORK PLAN (also include budget proposal items, demonstrating how work plan relates to budget)

GOAL ACTION PERFORMANCE MEASURE DUE RESPONSIBILITY 1.

LIST EXPENSE ITEMS FROM BUDGET PROPOSAL C. THAT RELATE TO GOAL 1:

LIST EXPENSE ITEMS FROM BUDGET PROPOSAL C. THAT RELATE TO GOAL 2:

LIST EXPENSE ITEMS FROM BUDGET PROPOSAL C. THAT RELATE TO GOAL 3:

Assessment points for 1. Description of Project /5

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2. NEED AND URGENCY FOR THE PROJECT DIRECTIONS 100 word maximum It is suggested that applicants use the following questions to demonstrate their ability to meet this assessment criteria:  Why is this project important for reducing illegal dumping?  Are there compliance issues and will the project bring you into compliance?  What is the population within a five-mile radius of the illegal dumpsite?  What schools, hospitals, businesses, and industries are within five-miles of the illegal dumpsite?  What is the distance to the nearest groundwater, river, stream, or arroyo?  What is the name of river, stream, or arroyo if known?  What fire hazard or vector problems does the illegal dumpsite pose?  Is the illegal dumpsite active? (i.e., is it still growing?) (Attach additional pages, if needed)

DESCRIPTION OF THE NEED AND URGENCY FOR THE PROJECT

Assessment points for 2. Need and Urgency for the Project /5

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3. FEASIBILITY AND SUSTAINABILITY (Includes ‘Commitment of your organization to the success of this project’ and ‘funding security’) Commitment of your organization to the success of this project

DIRECTIONS: 100 word maximum It is suggested that applicants use the following questions to demonstrate their ability to meet this assessment criteria: (Attach additional pages, if needed)  Why will this project succeed and continue beyond the grant funds?  Were there alternative solutions considered and if so, why were they not chosen?  Has the applicant proven sustainability with any other program(s)?  Are there any health, safety, or environmental risks that may be associated with the project?  What type of communication and education activities will support this project?

DESCRIPTION OF THE COMMITMENT OF YOUR ORGANIZATION TO THE SUCCESS OF THIS PROJECT

6 NEW MEXICO RECYCLING AND ILLEGAL ILLEGAL DUMPING DUMPING ALLIANCE GRANT APPLICATION FORM

Funding security DIRECTIONS: 100 word maximum It is suggested that applicants use the following questions to demonstrate their ability to meet this assessment criteria: (Attach additional pages, if needed)  How will this program be funded in the future?  If this grant cannot be fully funded, what costs can be eliminated/reduced or what alternative financing is available to assure completion of the project?  Can this project be implemented without this application being funded?

Description of funding security

Are there any other grant monies from other organizations for this project? Please check  Yes No If yes, please specify $ Granting Organization: Assessment points for 3. Feasibility and Sustainability /10

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4. COMMUNITY ILLEGAL DUMPING PLAN DIRECTIONS: Complete and attach either your existing Community Illegal Dumping Plan, OR the completed Community Illegal Dumping Plan using the sample provided. Assessment points for 4. Community Illegal Dumping Plan /5

5. PROPOSED BUDGET DIRECTIONS: Complete and submit Part C. Budget Proposal. See definitions for what “in-kind” may include. Assessment points for 5. Value for Money /5

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B. CERTIFICATION DIRECTIONS: All applicants must complete “Part B: Certification”

IS THERE PENDING LITIGATION OR OTHER CONTINGENT LIABILITIES THAT HAVE A BEARING ON THIS PROJECT OR APPLICATION? __YES __NO (IF "YES", EXPLAIN)

HAVE ALL PARCELS OF LAND AND RIGHTS-OF-WAY NECESSARY FOR COMPLETION OF THIS PROJECT BEEN PURCHASED, LEASED, OR OTHERWISE ACQUIRED BY THE APPLICANT? __YES __NO (IF "NO", EXPLAIN)

I, the undersigned, do hereby certify that I am an authorized agent of the applicant. (Authorized agent must be a Mayor; City or County Manager; Tribal or Pueblo Governor, Chairman of County Commission; or President, Chairman or Executive Director of a Cooperative Association or Solid Waste Authority.)

Furthermore, I attest that I have the legal authority to sign for our organization’s financial and personnel commitment to this grant proposal.

If a grant is awarded as a result of this application, we will comply with all applicable local, state, and federal regulations and requirements.

To the best of my knowledge and belief, the information contained in this application is accurate and complete.

Signature of authorized agent Title of authorized agent

Printed name of authorized agent Date

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C. BUDGET PROPOSAL

CAPITAL EQUIP. BASIS OF GRANT APPLICANT CONTRIBUTION TOTAL * EXPENSE ITEM DESCRIPTION* BUDGET APPLICATION (IF APPLICABLE) ESTIMATE** AMOUNT IN-KIND CASH 1.

TOTAL

BUDGET SUMMARY IN-KIND CASH TOTAL TOTAL TOTAL PROJECT APPLICANT CONTRIBUTION (applicant contribution plus grant application amount)

*Capital equipment expense items MUST include a proposed make, model and/or further description of the item budgeted. Attach additional sheets, if necessary. **How did you come up with your budget figure? For example, quote, estimate, published price?