FORESTRY ASSISTANCE APPLICATION FORM Forestry Assistance Application Form Landowner Name(Required) Landowner First Name Land Owner Last Name Address(Required) Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Contact Person (if other than landowner) Email(Required) Phone(Required) Service Location Address(Required) County(Required) Number of Acres(Required) Approximate Number of Homes within 1000 Feet of Your Property(Required) Is there a house on this property?(Required) YES NO Are you interested in having an assessment of how you could reduce the risk of wild land fire and create defensible space around the residence and other structures on your property?(Required) YES NO Has this property been awarded any grant funding for hazardous fuel reduction in the last 20 years? YES NO If yes, please list here: Has this property been burned by wildfire in the last 30 years?(Required) YES NO Would you like to receive specific information regarding fuels reduction assistance?(Required) YES NO Are you interested in cost-share assistance for fuels reduction work?(Required) YES NO We prefer to have the landowner present when the exterior hazardous fuels evaluation is performed. In the event you are unable to be present on site, do you give permission for personnel from the Montana West Economic Development Hazardous Fuels Program to access your property and perform the evaluation in your absence?(Required) YES NO Please provide directions to your property, including any distinguishing features or landmarks we can use to identify the property entrance if it is not clearly signed at the point it joins the public throughway. I understand that the performance of a Wildfire Risk Assessment does not obligate me to participate in the Hazardous Fuels Reduction cost-share program, nor does it guarantee the availability of funds if I elect to participate in the program.(Required) I UNDERSTAND CAPTCHA Δ
