Conservation Corps Project Request Form

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Host and Host Agency Info

Thank you for your interest in partnering with Conservation Corps! Upon submission of this form, a copy will be emailed to you for your records. Corps staff will receive notification of this request and will reach out to you to discuss project details and next steps toward a fully executed agreement. If you need technical assistance with this form, please contact nicole.zyvoloski@conservationcorps.org

Project Host Agency/Organization

Project Contact First Name

Project Contact Last Name

Project Contact Title

Phone Number

E-Mail Address

A copy of this completed form will be sent to the email address provided here.

Project Contact Street Address

Project Contact City

Project Contact State

Project Contact Zip Code

Additional Project Contacts (Field technicians, accounting staff, etc.)

Name, title, email address. Record individuals on separate lines.

Project Information

Name of Project

60 character limit for project name

Project Address

Address & Map

Street Address

City

State

Zip / Postal Code

Country

Project Location Information (area, site, etc. Include Map and/or directions for crew to find site):

Map of Project Location

Project Purpose:

Project Explanation (please be as detailed as possible):

Additional Project File

Project Training and Scheduling Information

Project Host(s) Able to Provide Training?

YesNo

Trainer(s)

Position/Title

Availability (Hours available for Training)

Project Host(s) to Provide Site Orientation, Project Overview & History, or other Training for Crew?

YesNo

Crew Type Requested

Estimated Length of Project

Preferred Project Timeline (what months/part of year?)

Can the Project be completed Intermittently?

YesNo

Corps Manager Requested for this Project

Deadline for Response from the Corps

Use this to indicate when you need a response from the Corps about our ability to take on this project.

Project Funding Information

Specific notes about the project funding stream are not required, but it can be helpful to know whether there are mixed grant sources or any kind of cost share supporting the project.

Amount of Funding Available:

Funding Detail/Source(s):

Priority for this Project (i.e. funding expires if not used by specific date, staffing availability, etc.)

Is the project funded through Legacy Amendment Parks & Trails Funding?

YesNo

Is the project funded through Outdoor Heritage Funding?

YesNo

Is the project funded through MN DNR Natural Resources Dedicated Funds?

YesNo

Is the project funded through Legacy Amendment Clean Water Funding?

YesNo

Project Detail

Alternate work plan in the event of adverse weather (if applicable)

Safety concerns or potential "watch-out" situations related to project. List any specialty safety equipment requirements.

Cell Phones Work in Project Area

What communication system will be made available to team in event of emergencies?

Listing of all types of hand tools required for project:

Listing of all types of power tools required for project:

Agency able to provide specialized tools?

Union certification requirement for MN DNR projects only; all other requesters select "no" and proceed directly to the submit button below.

Project Funded By MN DNR?

MN DNR Requester MUST notify their AFSCME Union Representative of this project request.

Certification: As project host with the MN DNR, I certify that the assignment of Conservation Corps Minnesota members will not result in the displacement of currently employed workers or workers on seasonal layoff or layoff from a substantially equivalent position, including partial displacement such as reduction in hours of non-overtime work, wages, or other employment benefits. Further, MN Conservation Corps members will not perform services or duties that have been performed by or were assigned to any employee who is on strike or is being locked out.

Check box below to indicate notification of union representative(s) has been completed.

Union notified.If not completed, see Step 1 on the DNR Intranet page.

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