C OLO R ADO P AR K S & W I L DLI F E
Columbine License & Pass Application
Colorado Parks and Wildlife offers the Columbine program for customers with disabilities. These customers qualify for
a free Lifetime Fishing License as well as qualify to purchase a reduced-cost annual parks pass. To qualify, customers
must be Colorado residents and have a total and permanent
disability. Please fill out this checklist and application in its
entirety to expedite your request.
Program Qualification Checklist:
Submit applications and documentation
Requested Product(s): Please mark which product(s) you are applying for
OR mail to:
Columbine Annual Parks Pass
Colorado Parks and Wildlife
o If mailing in application, please include check or money order
Attn: Columbine Program
for $14, payable to CPW.
Columbine Lifetime Fishing License
the below are required to prove Colorado residency for this program
Applicant has lived in Colorado for at least six (6) consecutive months immediately prior to the date of application, AND
Applicant* has a valid Colorado driver’s license or Colorado state ID.
*Applicant is a youth; please provide parent or legal guardian’s Colorado driver’s license or state ID #: ____________________
Total and Permanent Disability Proof
“Final Admission of Liability” form from the Division of Workers Compensation which indicates the applicant has a
“permanent total disability” OR
A completed “Physician’s Affidavit” provided on the second page of this form.
Without proper documentation, we will be unable to process your application. Please be sure to fill out the application legibly and
completely. Any missing information will delay processing of your request and may result in your application being denied.
Colorado Driver s License or ID #
Month & Year Started Living in CO
Hunter Education Number & State
Month ______ Year _______
I certify that the information provided on this application and any provided documentation is true and accurate. I hereby authorize
Colorado Parks and Wildlife to make further inquiries to verify information provided on this affidavit which may include contacting
my physician, physical, occupational, or recreational therapist. I understand that any false statements made will void my license
and/or pass and may result in criminal charges.
Signature of Applicant ___________________________________________________________ Date ____________________________
COLORADO PARKS & WILDLIFE • 6060 Broadway, Denver, CO 80216 • (303) 297-1192 • cpw.state.co.us
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