lhapplication - lls flood recovery grants application form ... web view’s national landcare...
TRANSCRIPT
Hunter Local Land Services Flood Recovery Grant Application Form – 2015-16
This form is to be used to apply for funding under any Hunter Local Land Services (LLS) Grants Programs. Please refer to the Grants Program Guidelines for further information about the terms and conditions of applying for LLS funding.
Funding for LLS Grants programs is provided from a variety of sources including the Australian Government’s National Landcare Program, New South Wales Government’s Catchment Action NSW, and Hunter Catchment Contributions.
1. PROGRAM DETAILSWhat LLS Grant Program are you applying for funds through?Please refer to the Guidelines for each Program for grant eligibility and identified priority areas.
If you are eligible, only one program can be applied for per application form.
Hunter Flood Recovery Program
Flood Readiness Program
Torryburn Green Army Assistance Program
Note: Your application may also be considered for funding under other LLS Programs.
2. APPLICANT AND PROPERTY DETAILSApplicant (The name at the Applicant should match the name of ABN holder if provided)
Contact Person Mr/Mrs/Ms
Landowner(s) (if not applicant) Mr/Mrs/Ms
Is the applicant an Aboriginal or Torres Strait Islander individual or organisation?
Yes No
Property Address (Project Location) Applicant Postal Address
Suburb: Postcode Suburb: Postcode
Contact DetailsTelephone Home: Bus: Mob:
Project Location:Lot/DP:
Property Identification Code (PIC):
LGA:
Area of proposed project (Ha)
Total Area of Property (Ha)
HRXXX – Grant Application - Name Page 1 of 10
Event Number(LLS office use only)
ABN and GST Status
Registered Business name:
Are you currently registered for GST?
Yes No ABN:
Group membership
Are you affiliated with an Industry, Landcare or community group
Yes No
Group name: _____________________________________________
Property Planning
Do you have a current Property Plan?
Yes No
If no, would you be interested in undertaking training? Yes No
3. PROJECT DESCRIPTIONPlease provide a description of your project and the objectives you are aiming to achieve. Include your production, environmental, cultural, and social objectives.
Project Description:
HRXXX – Grant Application - Name Page 2 of 10
4. TECHNICAL ADVICE AND CONSULTATIONPlease provide details of what advice you have sought or consultation you have undertaken in developing your application.
5. RELEVANT LAND MANAGEMENT EXPERIENCEPlease provide an outline of your experience in land management, including details of any relevant training or qualifications you have.
HRXXX – Grant Application - Name Page 3 of 10
6. PROJECT PLAN
What are you proposing to achieve through implementing the project (outcomes)?
Examples: re-establish native vegetation; improve groundcover and pasture species composition, raise
community awareness
What works or activities will you undertake?Examples: Plant & establish 500 trees; 2km fencing to exclude stock from stream; install 5 stock watering points, control 2ha of lantana & blackberry
Completion date?(month & year)
(Implementation of projects must be completed by 31 December 2016
according to project plan timeframes)
7. PROJECT BUDGETNote: For estimate purposes landholders/community groups should cost their in-kind labour component at $30/hour.
LLS funding is provided exclusive of GST. Please see the LLS’s GST Fact Sheet for more advice on funding and the GST implications.
Proposed activity/work/action Examples: Plant trees, erect electric fence
Unit of Measure Quantity Unit Cost
(excl GST)Total Item Cost (Excl
GST)
LLS Funds Sought
(Excl GST)
Own Cash Contribution (Excl GST)
Own Labour In-kind
@$30/hr
Total – funds sought + in kind+ cash contribution
(Excl. GST)GST
TOTALSNOTE: An excel version of the budget sheet is available from your Hunter LLS Contact Officer upon request.
HRXXX – Grant Application - Name Page 5 of 10
8. MONITORING, MAINTENANCE AND REPORTINGHow will you monitor whether your project is achieving
the Outcomes?(BOLD rows are mandatory)
Tick adopted monitoring techniques.
Frequency or due date
Photo-point monitoring Before and after photos of works Step Point transect for assessing groundcover Event evaluation sheets Attendance records Pasture composition quadrats Tree survival rates Final Report Grazing records/Plan
8. ABORIGINAL CULTURAL HERITAGE AND CONSULTATION
Checklist Questions Yes No
Do you know of any Aboriginal sites or objects on your property or in the immediate area?
Are you aware of any Aboriginal history, stories or significant events that took place on your property or in the immediate area? If YES, please provide a brief description below.
Is your project area located near a river, stream, lake, wetlands or watercourse?
Does your project area contain any of the following landforms: rocky or sandy hills, mountains, claypans, caves, sandstone overhangs?
Will there be any native vegetation removed permanently?
Are you interested in planting any native vegetation on your property?
Will there be any ground disturbance involved in the project? If YES, please provide brief description below.
Is the property on private (freehold) land?
Do you give permission for relevant project information to be provided to the Local Aboriginal Land Council for the purpose of cultural heritage assessment?
Other Notes:
10. PUBLIC LIABILITY INSURANCEYes No
I currently have Public Liability Insurance and a copy is attached
If you currently don’t have this insurance coverage, are you willing to acquire $10 million public liability coverage, if you are successful?
11. MAP OF PROPOSED PROJECT WORKSContact your Hunter LLS contact officer to discuss your project and to develop a map of your project area and works proposed for inclusion in your application.
You may also wish to provide photographs or a sketch of the proposed project site in the space provided below to support your application.
12. CONFLICT OF INTEREST
Outline any conflict of interest you may have with the business or any director or staff of Hunter LLS
HRXXX – Grant Application - Name Page 7 of 10
13. OTHER FUNDING
Please list any current or previous grants or financial assistance you have received that is relevant to the activities in this project.
Funding source Year Project title Amount Continuing commitments
Do you have any other related funding applications currently under consideration?YES / NO (If Yes list)
HRXXX – Grant Application - Name Page 8 of 10
14. DECLARATION AND SIGNATUREBefore signing please ensure your application is complete in all sections as incomplete applications will not be considered.
Successful applicants will need to adhere to the terms and conditions outlined in the Program guidelines.
If a company or organisation, the applicant must be an authorised representative of the entity.
I,Name of applicant (please print)
as the applicant confirm that all details outlined in this application are true and correct.
Signature of applicant Date
If you are applying to undertake a project on land of which you are not the owner, the landowner must also sign the application for private holdings or the responsible entity must sign for public land. If the landowner or responsible entity is a company or organisation, the signatory must be an authorised representative of the entity.
I,Name of land owner or responsible entity (please print)
as the landowner (or responsible entity) grant permission for the applicant to undertake the project on the land and confirm that I will be bound to all details outlined in this application.
Signature of landowner Date
Submission details for each Program are presented in the Program guidelines.
HRXXX – Grant Application - Name Page 9 of 10
Applicants Checklist for Grant Application
Do you have in your application for submission... Yes No
Have you attached your LLS generated map? Yes No
Have you attached a copy of your Public Liability Insurance? Yes No
Has the land owner or responsible entity signed the application? Yes No
Does the person/entity responsible for the agreement name match the name against the ABN number (if applicable)?
Yes No
Are you aware of LLS minimum activity standards and/or activity definitions for projects and that you will be required to deliver your project in accordance with these?
Yes No
Have you answered every question? Yes No
HRXXX – Grant Application - Name Page 10 of 10