Small GrantS– PROTECTING ABORIGINAL PLACES

2017-18application form

Applicationswill 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 or Individual
*Postal address
*Town / City / *Postcode
*Primary Contact Officer
Position Title
*Phone / Mobile
*Email
ABN
*Public Liability InsurancePolicy number
  1. 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 LLS staff? We encourage you to get in touch with the Aboriginal Cultural Landscapes project staff to discuss your ideas before applying.

☐Yes☐No

Have you discussed this project with you / the local Aboriginal Community – yes/no

*Proposed Project Outputs

Outputs / Number / Description
Total area of the project
List on-ground outputs
(e.g. number of plants for revegetation, length of fencing for site protection, area treated for weeds, area treated for pests etc)
Number of participants involved in on ground works
Number of awareness raising/training events
Number of participants involved at awareness raising/training events
Other
Why is this project valuable to your community? (Remember to consider the project goals outlined in the expression of interest fact sheet)
List any partners or collaborators for the project and a brief description of their role in the project
How will you use this project to build the cultural knowledge and values of your local community and local people?

Central Tablelands Local Land Services

Tel: 6333 2300 | centraltablelands.lls.nsw.gov.au

*Budget

Item / Total item cost / Grant funding budget for this item / Partner cash contribution (if applicable) / In-kind contributioneg volunteer labour, materials donotionetc
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 over the last 1-3 years?
(if Yes, provide details of the funding program, amount of funding and brief outline of the project and if it was completed)

☐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:

Greg Ingram | 0428205351|

Michelle Hines | 63419304 |

Please return your completed application to:

POST: 2017 Protecting Aboriginal Places Small Grants Application

Central Tablelands Local Land Services

PO Box 510
Cowra NSW 2794

EMAIL:

All applications must be received by 5pm on Friday 1st December 2017

Any incomplete applications will not be assessed.

Funding applications received after 5pm, 1st December 2017may be ineligible for funding.

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

Central Tablelands Local Land Services

Tel: 6333 2300 | centraltablelands.lls.nsw.gov.au