Small Grant for Groups and Schools

2017-18 application form

Applications will be processed as they are received until all funding is committed

Fields marked with * must be completed, incomplete applications will be returned to be completed

1.  Contact details

* Name of Group
* Postal address
* Town / City / * Postcode
* Primary Contact Officer
Position Title
* Phone / Mobile
* Email
ABN
* Public Liability Insurance Policy number

2.  Project details

* Project title
(20 words max)
Location of where on- ground works will be undertaken

Lot and DP details (Where works will be undertaken. If applicable)

Lot / DP / Lot / DP

* Project description

Project summary (250 words max – include detail of project activities, please attach additional information where possible e.g. plans, species lists)
Have you discussed this project with local LLS staff, Landcare Buddy or Regional Landcare Facilitator?

☐Yes ☐No

* Proposed Project Outputs

Outcome / Number / Description
Total area of the project
List on-ground outputs
(e.g. number of plants, length of riparian rehabilitation etc.)
Number of participants involved in on ground works
Awareness raising/training events
Number of participants involved at awareness raising/training events
Other

Central Tablelands Local Land Services

Tel: 6333 2323 | centraltablelands.lls.nsw.gov.au

* Budget

Item / Cost / Grant / Partner cash contribution / In-kind contribution
TOTAL
How will this project be monitored and maintained? (150 words max)
(At a minimum monitoring is to include photo points – before and after)
* Have you had any Natural Resource Management funding by a government organisation?
(if Yes, provide details of the funding program, amount of funding and brief outline of the project)

☐Yes ☐No

Details: Click here to enter text.

* Conflict of Interest

Do you know of any Conflicts of Interest for funding eligibility?

☐Yes ☐No

Details: Click here to enter text.

3.  DECLARATION

* I declare the information entered on this form is true and accurate to the best of my knowledge.

Name of applicant
Signature of applicant / Date

______

INQUIRIES:

Liz Davis | 6363 7872 |

Tim Nalder | 6363 7873 |

Please return your completed application to:

POST: 2017 Small Grants Application

Central Tablelands Local Land Services

PO Box 15
MOLONG NSW 2866

EMAIL:

All applications must be received by 5pm on 18th August 2017

Any incomplete applications will be returned and will result in a new submission date.

Funding applications received after 5pm, 18th August 2017 may be ineligible for funding.

Applications will be processed as they are received until all funding is committed.

Central Tablelands Local Land Services

Tel: 6333 2323 | centraltablelands.lls.nsw.gov.au