Released 13 November 2017

Australian Capital Territory Natural Resource Management (ACT NRM) - EXPRESSION OF INTEREST FORM

For

ACT Regional Land Partnerships (2018-2023)

National Landcare Program 2

Download the expression of interest guidelines from:

https://www.environment.act.gov.au/act-nrm/investment-plan/consultation

If you need additional assistance completing this form, please contact

(email)

(phone) 02 62053806 (Tim Wong)

  1. Application summary
  1. Name of applicant: ______
  2. Project title: ______
  3. Short description (100 words maximum)

4. Approximate cost of project: ______

5.Applicant ABN and GST Registration

5.1Please provide your ABN:……………………………………

5.2Are you registered for GST? No Yes

6. Statement about applicant

(Please provide a statement of no more than 250 words outlining the principle aims and objectives of your organisation. Applicants will need to demonstrate:

a) relevant expertise, experience and resources (including specified personnel, if applicable)

b) the ability to coordinate and obtain landowner/landholder and Traditional Owner agreement/support and access to secure land suitable to achieve environmental and sustainable agriculture outcomes

c) experience and ability to engage with community, including Landcare and farmer groups, and industry groups to deliver natural resource management projects

d) experience and expertise undertaking monitoring, evaluation and reporting on NRM projects

e) sound financial governance

f) experience and ability to provide a safe work environment consistent with work health and safety laws relevant to the jurisdiction(s)

  1. Information about the project

1. Alignment with Regional Lands Partnership Services and associated ACT NRM Investment plan outcomes (see EOI Guidelines, Attachment A)

(Please tick appropriate box(s) below, and provide an overview of no more than 250 words outlining the degree to which the project aligns with regional land partnership and associated ACT NRM Investment Plan outcomes, and also delivers upon multiple NLP and ACT outcomes).

 Threatened species services

 Ramsar services

 Threatened ecological communities services

 Soil, biodiversity and vegetation services

 Supporting agricultural systems services

2. Project outcomes

(Please provide an overview of no more than 250 words outlining indicative outcomes you will achieve through your project)

3. Project activities

(Please provide an overview of no more than 250 words outlining how your project will be delivered, including the proposed duration of your projects, and how it will achieve project outcomes).

4. Indicative project budget, relevant and value for money

(a) Budget table

Category of costs / BASIS OF COSTING
(e.g. number of seedlings, hectares of treatment, contracted hours) / ACT Regional Land Partnerships funding requested ($) / OTHER contributions ($)
(e.g. in-kind and cash) / TOTAL ($)
(GST exclusive)
1. Salaries
(indicate FTE if applicable)
2. Consultants or contractors
3. Materials (e.g. trees, chemicals)
4. equipment hire
5. Communications / marketing
6. Monitoring and evaluation
7. Administration (e.g. on-costs, audit)
8. Other costs (please specify)
TOTAL

(b) Relevant expertise

(If you have specified any salaries or consultants in the budget table above, please provide descriptions about the skills and experience required. You may also wish to attach a CV of any specified personnel).

(c) Value for money

(Please provide an overview of no more than 250 words outlining how your project demonstrates value for money)

5. Community engagement

(If applicable, please provide an overview of no more than 250 words outlining how your project will engage with community, including landcare, farmers groups, indigenous people and others, to deliver on ground projects)

6. Aboriginal NRM

(If applicable, please provide an overview of no more than 250 words outlining how your project will support the aspirations of the indigenous community in the ACT, as outlined in the priorities identified in the ACT NRM Investment Plan)

C.Certification

Authorisation by applicant or sponsor

(This section should be signed by the chair or president of the organisation or group.)

I ……………………………………………of ………………………………………………

State ……… Postcode ……… certify that the information given in this application is true and correct to the best of my knowledge.

Signature: ……………………………… Date: … / … / ………

Name (please print): ……………………………………………...

Position (if applicable): ………………...... …....…………… Phone: ………...... ……

Organisation/group:………………………………………………………………………

Email: …………………...... ……………………

Mailing address:………………………………………………………...…………………

……………………………………………………………………………………………………………………

D.Submission of Expression of Interest

Applications must be received by AEST 5pm on Friday 15 December 2017.

a) You can email PDF copies of your application to:

ACT NRM at

b) If you are unable to email your application (as above), please send a paper application by AEST 5pm on Friday 15 December 2017 to:

ACT NRM

Nature Conservation Policy

Environment and Planning Directorate

GPO Box 158

CANBERRA ACT 2601

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