Special Use Permit Application

STATE OF ALASKA

DEPARTMENT OF NATURAL RESOURCES

DIVISION OF PARKS AND OUTDOOR RECREATION

SPECIAL USE PERMIT APPLICATION
A Special Use Permit (SUP) is required for anyone conducting activities (as defined in 11 AAC 18.010) within any unit of the State Park system. Examples of activities included the reservation and exclusive use of picnic shelters (not on Reserve America); groups or events of 20 or more people; special events including but not limited to wedding parties; family reunions; research activities (i.e. collecting plants or animals/insects for scientific or educational purposes); educational activities (school field trips); scout troop events, special access, church outings, motorized access, boat storage, etc.

Any SUP application must be submitted online with sufficient time given for review, planning, and permit processing. All SUP applications are considered on a first-come, first-served basis. Please refer to the fee schedule on the permitting page for additional details on activities and permit fees associated with an SUP.

Please completely fill out the application. Only complete applications will be processed. Allow up to 30 days for permit processing.

FOR ADDITIONAL INFORMATION, contact the permitting office at:

specialusepermits@alaska.gov

Applicant Information
Name*

First NameLast Name
Email*
Phone Number*
Please enter a valid phone number.
Emergency Contact Name*
Emergency Contact Phone Number*
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Company/Organization Name
Is the sole purpose of the activity related to a youth educational activity organized by a school, government agency, or non-profit?*
Please provide EIN (non-profit only)
School or government agency put NA
Park Unit and Requested Activity

Please include the Park Unit and specific Park Facility/Area you would like your requested activity to take place
Check All Park Regions that apply;

Northern (Fairbanks to Tok including Fielding Lake)MatSu (Denali State Park, Hatcher Pass, Nancy Lake)Chugach (Eklutna to Turnagain Arm)Kenai (Kenai River and Peninsula to Valdez)Southeast (Ketchikan, Wrangell, Sitka, Juneau, and Haines)Southwest (Kodiak and Dillingham)
Requested Use Areas*
Will you be operating at Eagle River Nature Center?*

YesNo
I agree and understand that by operating at the Eagle River Nature Center I must have the Friends of Eagle River Nature Center listed as additionally insured on my insurance policy.*

I agree and understand
I agree and understand that by operating at the Eagle River Nature Center I am responsible for paying Friends of Eagle River Nature Center's day-use parking fees.*

I agree and understand
Please provide a description of requested activity, be as specific as possible.*

Example: Dock Installation, River Bank Stabilization, Event, Motorized Access, Parking/Storage, Research, Trail Grooming etc. 0/250
Is this an event such as a wedding, race, family reunion etc.:*

YesNo
Have you already or will you reserve a park facility such as a picnic shelter, campground, or public use cabin associated with your activity?*

yes I have a reservation or will make a reservation on Reserve Americanot needed with my requested activity
Does this activity require a fee to be paid to your organization in order to participate (i.e. race event)?*
How much is the fee (per person)?
Estimated number of participants/people attending*
Date(s) of Requested Activity*
For the requested activity, attach supplemental information if necessary (ex: maps, construction plans, ADFG habitat permit, etc.)

If your files don't attach it is because the file size is too large or file type is not supported by State of Alaska. Please reduce file size or convert to an Adobe PDF. NO GOOGLE DOCS OR GOOGLE DRIVE LINKS
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Permit Stipulations

Special Use Permit General Stipulations
Special Use Permit General Stipulations
Signature
I attest the information submitted on this form and any attachments are true, complete, and accurate to the best of my knowledge. The permittee has read and agreed to the terms of this permit and understands that the breach of any of the terms is cause for revocation or suspension. By signing this form, the permittee, its agents, and employees agree to conduct the authorized activities under this permit in accordance with the attached general stipulations and special stipulations, that are incorporated upon the issuance of this permit.
Signature*

Clear
Date of Signature*

MonthDayYear
Should be Empty:

Applicant Information

Park Unit and Requested Activity

Permit Stipulations

Signature