2015 Bush Connect Application Form

Application Form

Closing date 5:00pm 19June 2015

About the program

Bush Connectwill fund and support community driven, consortium-based projects with an emphasis on on-ground activities to improve the condition of the natural environment within the New South Wales (NSW) portion of the Great Eastern Ranges (GER) corridor. Projects will be large-scale (tenure blind) and long-term (10 years).

For further information, please refer to the Bush Connect Program Guidelines.

Using this document

This document is the application template for the program and contains guidance on how to complete it. A variety of text styles have been employed throughout this document, and can be interpreted as follows:

Grey boxes () represent sections which require your input. These boxes will expand as you type, however, the amount you can enter is restricted to the size of text boxes provided - please ensure you make good use of the available space.
Guidance on type of information required for each question/section has been provided.

Questions
If you require assistance with completing the application form, please contact the
Environmental Trust on (02) 8837 6093 or
Lead Applicant:
Project Title:
Funding Requested: / $

Provide location information for your project. Decimal degrees can be determined by accessing Google maps, navigating to your project site and right-clicking on ‘What’s here?’

Main local government area
Local Land Services area / Select 1Northern TablelandsNorth CoastHunterCentral TablelandsGreater SydneySouth EastRiverinaMurrayWesternCentral WestStatewide
State electorate
Latitude (decimal degrees)
Longitude (decimal degrees)
Provide location map(s) and plan(s) of your project site(s) as attachments with your application.
Name of organisation
ABN / Registered for GST / Yes or No
Postal address
Suburb / State / Postcode
Community group / Not-for-profit organisation
Incorporated association / Other (please specify below):
Title / First name / Surname
Position / Daytime phone / (0)
Mobile / Email
Title / First name / Surname
Position / Daytime phone / (0)
Mobile / Email
How does your organisation make decisions?
(e.g. Board, Committee, Quorum of members, etc.)
Office Bearers: / President/Chair/CEO
Treasurer/CFO
Are your officer bearers: / Elected / Appointed
Number of years operating: / Registration no.
Number of employees / Full-time / Part-time
How many members are there in your organisation?
Can members of the public join your organisation? / Yes / No
Yes or No
Program
(e.g. Restoration and Rehabilitation) / Reference number / Project name / Amount / Status
$
$
$
$
$
Yes or No
Funding source / Year / Project name / Amount / Status
$
$
$
$
$
Company
Policy No.
Coverage
Currency (expiry date)
Name of organisation
Administrator’s ABN? / Registered for GST / Yes or No
Postal address
Suburb / State / Postcode
Contact: / First name / Surname
Position / Daytime phone / (0)
Mobile / Email

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Bush Connect projects are expected to be implemented through the collaborative efforts of a group of organisations (a Consortium).

Partner organisation name / Contact details / Role in project / Governance agreement
E.g. East-West Local Land Services / John Citizen – Team Leader Land Services. (02) 4399 1234 / Coordinator of four private landholder project sites. Will oversee bush regeneration and fencing contractors working on those sites and liaise with landholders. Responsible for vegetation monitoring for those sites. / Memorandum of understanding detailing expected contributions and input of E-W LLS signed on 21 May 2015.
E.g. National Parks and Wildlife Service (Rocky Creek NP) / Joan Smith - Ranger (Rocky Creek National Park). (02) 4399 1235 / Oversee linkages of new habitat corridors with existing National Park Reserve. Arrange promotion of the project to park visitors. Maintenance of regeneration works within National Park. / Letter of support outlining in-kind contribution value and commitment terms.

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Partner organisation / Purpose of Funding / Trust funding allocated ($) / In-kind contribution ($) / Cash contribution ($) / Total ($)
E.g. East-West Local Land Services / Ecological restoration and fencing on project site to reduce threats. Monitoring of reduction in threats and response of species. / $50,000 / $50,000 / $30,000 / $130,000
TOTAL
Organisation or group / Type of organisation
(Community group, individual, business, etc.) / Description of
their interest, views or key skills / Type of engagement in the project
E.g. Rocky Creek Twitchers / Community group / The group has been active for several years and have strong local knowledge on bird species in the area. They are interested in improvements to local bird habitat, particularly for rare and endangered species / The group have agreed to assist with monitoring the project by conducting regular (bi-annual) bird surveys in set locations
E.g. Rocky Creek Hardware and Landscape supplies / Business / Important hub for the community / The store has agreed to put promotional materials in their shop window and is providing $500 toward fencing materials

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Objective 1:
What would success look like?
Activity
(Significant steps or actions that are
needed to produce the identified objective) / Project measures
(refer to Project Measures table for a range of measures that may be suitable for your project) / Total
projected
(this is what you
aim to achieve by undertaking the activity) / How will you monitor your progress? / Year activity will be undertaken?
(may occur over multiple years] of the project) / Activity
completion date(s)
(this should be the actual date you intend to complete each activity)

Lay out your project objectives (up to three), vision of success and activities for achieving this. A list of relevant Environmental Trust Project Measures can be found on the Trust website. Make sure you also include appropriate monitoring methods for determining the effectiveness of each activity. An example of a completed objective tableis available on the Trust website.

Objective 2:
What would success look like?
Activity
(Significant steps or actions that are
needed to produce the identified objective) / Project measures
(refer to Project Measures table for a range of measures that may be suitable for your project) / Total
projected
(this is what you
aim to achieve by undertaking the activity) / How will you monitor your progress? / Year activity will be undertaken?
(may occur over multiple years] of the project) / Activity
completion date(s)
(this should be the actual date you intend to complete each activity)
Objective 3:
What would success look like?
Activity
(Significant steps or actions that are
needed to produce the identified objective) / Project measures
(refer to Project Measures table for a range of measures that may be suitable for your project) / Total
projected
(this is what you
aim to achieve by undertaking the activity) / How will you monitor your progress? / Year activity will be undertaken?
(may occur over multiple years] of the project) / Activity
completion date(s)
(this should be the actual date you intend to complete each activity)

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Site
(map reference) / Landowner / Consent Status
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Permission granted In-principle approval No approval
Studies, reports, assessments or plans
e.g. local environment plans,
catchment action plans, vegetation management plans,
state of the environment reports? / Describe which particular component of the
document/s your project relates to and how it will attempt to address the issue/meet a particular target.

List any threatened species, populations and EECs relevant to your project site/s (as listed under the NSWThreatened Species Conservation Act 1995.) The Saving Our Species conservation projects database provides a map showing the location of all threatened species and populations in your LGA for your reference.

Common Name / Scientific Name / Saving our Species Management Stream

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Two documents exist to assist you with completing table 4.2:
1. Risk Management Framework (guidance on how to complete table 4.2)
2. Corridor Risk Assessment Framework (a guide to identifying and managing risks specific to habitat corridor creation). / I have read both of the above documents
Potential Risk
Step 1 / Likelihood
Step 2 / Impact
Step 3 / Rating
Step 4 / Mitigating actions
Step 5
E.g. Increased risk of bushfires being hosted and spreading via using the vegetation corridors created through the project / Moderate / Major / High / Ensure minimum buffer zones are retained between revegetation areas and buildings/assets. Consider appropriate fire regimes for future implementation in consultation with RFS and NPWS.
E.g. Fox harbour and passage enabled by the creation of the habitat linkages / Moderate / Moderate / Medium / Establish fox monitoring and baiting program to be conducted by East-West Local Land Services an in-kind contribution.
Funds / Year 1
$ / Year 2
$ / Year 3
$ / Year 4
$ / Year 5
$ / Year 6
$ / Year 7
$ / Year 8
$ / Year 9
$ / Year 10
$ / Total
Environmental Trust Grant / N/A / N/A / N/A / N/A
Consortium financial contribution
Consortium in-kind contribution
TOTAL

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Referee 1 / Referee 2
Name / Name
Title/position / Title/position
Organisation / Organisation
E-mail / E-mail
Phone no / (0) / Phone no / (0)
Mobile no / Mobile no
Fax no / (0) / Fax no / (0)
Name
Title/position
Organisation
E-mail
Phone no / (0)
Date

Note:If the project is on land owned by the office-bearers, those office-bearers cannot authorise the application

Name
Title/position
Organisation
Email
Phone No. / (0)
Date

Please provide some basic feedback on your experience with applying to the Bush Connect program. All feedback will be collated to provide overall picture and used to assist development of future Environmental Trust documentation.

<5 hours / 5-20 hours
20-40 hours / >40 hours
2 hours / 2-5 hours
5-10 hours / 10 hours
Very easy / Easy / Moderate / Difficult / Very difficult

Grant application checklist

Answer all the questions in the application.
Include a completedfull budget template (financial information) with your application.
Have your application authorised by the appropriately delegated person.
Attach all required supporting information: certified organisational documents, CVs (maximum two page), briefs and job descriptions, letters confirming other funding. Additional information should be kept to a minimum. If your application refers to a large document, only include the relevant pages of that document i.e. title page, executive summary, relevant pages.
Attach as many maps as necessaryto clearly show the layout of your project site(s).
Submit your application by the closing date–5.00pm 19 June 2015
We are unable to accept faxed applications or posted hardcopies.
If your application and attachments are greater than 10MB, you may post a USB hard drive or CD containing these files along with a cover note to the below address.
Email to: / /

Ensure you email your entire application, including all attachments, e.g. maps; CVs.
Note:Emailed applications must not be larger than 10MB including all attachments.
Please email the application form as a Word document and the budget spreadsheet as an Excel document - DO NOT PDF.
Attachments can be emailed as Word, Excel or PDF documents.

Postto: / NSW Environmental Trust
PO Box 644
PARRAMATTA NSW 2124 /

USB or CD only with cover letter

Any application that is late, incomplete or not eligible will not be considered.

Published by the NSW Environmental Trust, PO Box 644, Parramatta 2124 Phone: 02 8837 6093 Fax:02 9895 6548

Email: Website: OEH 2015/0216 April 2015

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