Application Form–2016Bushcare Grants

Applications must be received or postmarked by 4.00pm Friday1stof April2016

Please note: If you require assistance with your application please contact Rachael Major on

9670 3119 or email before the 30th of March 2016.

Bushcare grants will provide funding of up to $15,000 per property

Contact Details:

Applicant name(s):

Applicant Type:

☐Community Group☐Local Government☐Individual☐Group of Landholders

☐Other(Please specify):

Are you under 34 years old? Y/N

Contact Person:

Phone:(H) (M)Fax:

Email:

How would you like us to contact you?EmailPhonePost

Postal Address:

Are you registered for GST? Yes / No

Do you have an ABN?Yes / No

If yes please provide your ABN:

Please provide a brief description of your Project:

Will the project activities take place on more than one property? Yes / No

What is the location of your Project?

(please give as much detail as possible so we can find where your project will be)

GPS coordinates (if known):

Road Address:

Have you been involved in a similar project in the past?Yes / No

If yes please provide a brief outline (funding source, activity, year):

Briefly explain why this patch of bushland is important to you?

Description of Bushland

Please note:Additional information in describing your bushland can be provided in the appendices section at the end of this application form.

How big is the patch of bushland? Hectares Acres Unsure

Please provide a brief description of your bushland (plants, animals etc):

What do you see as the main threats to the bushland you are trying to protect?

☐Feral Animals☐Weeds☐Salinity☐Stock Access ☐Erosion ☐Fire ☐Other (please specify):

Further Comments:

What activities will you undertake? (Please attach a map showing the location of activities)

☐Installation of new and/or replacement of existing, stock proof fencing

Kilometres required:

☐Revegetation

On cleared land (ha):

Within bushland (ha):

☐Feral Animal Control

Control area (ha):

☐Weed Control

Control area (ha):

☐Waterway Management

Describe activity (Such as installing riffles):

How will these activities benefit your bushland?

How many participants and who will be involved in project activities?

Landholder:Landholder and family members.

School:

Family and Friends:

Community Groups: Appropriate groups and volunteers would be welcome to assist with project work if required.

Other:

What activities will you undertake to maintain the project area in the future?

(For example ongoing weed and rabbit control, no grazing by stock)

Time Frame:

Intended Project Start Date:

Intended Project End Date:

Budget:

What is the total cost of your activity?

What is the total amount of funding you are requesting?

What other funding or in-kind contribution are you bringing to the project?

Please provide an outline of how you wish to allocate the funds using the Project Budget below

Project Budget

Description of activity / Quantity / Funding requested / In-kind (landholders) contribution / Total
Fencing ($2500/km) / Km
Planting and site prep
Seedlings
($850/ha) / Ha
Environmental Weed control
1080 Rabbit bait
1080 Fox Bait
Fox Cage trap / Supplied by WNRM
Total

Please save this form to your desktop and attach in an email to

Alternatively please print the completed form and post or fax to:

Rachael Major

Wheatbelt NRM

PO Box 311

Northam WA 6401

Fax: 08 9670 3140

Appendix 1

Please note this section is not compulsory for your application but will assist the assessment process. If left blank Wheatbelt NRM may contact you for further information.

Please provide photos of Bushland to support your application.

Click on the boxes below to insert a photo from your computer.

If digital photos are unavailable please contact Rachael Major on 9670 3119 for alternate methods.

Photo 1Photo 2Photo 3

Landform:

☐Waterway☐Valley Floor☐Granite Outcrop ☐Hilltop☐Other

Trees:

How many different types are there?

Name of dominant species if known:

Shrubs:

How many different types are there?

Name of dominant species if known:

Understorey (Ground Level Plants):

☐Weeds

☐Native Grasses

☐Native Ground Cover

☐Annual Wildflowers (for example Orchids or Everlastings)

☒Other

1

Project Map

Further information: Please attach or draw a project map showing where the different activities:

1