Corangamite CMA Coastal Small Grants

Round 5

Applications must be submitted to the Corangamite Catchment Management Authority P.O. Box 159, Colac VIC 3250 or by email to

For an electronic copy of this form please email .

SiteCode (as assigned to you by Corangamite CMA staff member)
Project summary (maximum 100 words)
Group details
Group name:
Group Incorporation Number:
ABN Number: / GST Registered? Yes / No (please circle)
Is your group an Aboriginal group? Yes / No (please circle)
Who should receive all correspondence?
Name:
Postal Address:
Phone Number / Mobile Number / Fax Number
Email Address:
Which public land manager is the project in partnership with?
Organisation:
Contact person:
Postal Address:
Phone Number / Mobile Number / Fax Number
Email Address:
Onground project site details

Please attach / insert associated Management Plan prepared by Corangamite CMA Catchment Officer.

Community engagement project description
Community capacity building is a crucial aspect of the Coastal Small Grantspackage and to achieving environmental outcomes. Projects need to demonstrate an appropriatecontribution to building the capacity of the community through the project, such as field days, volunteer opportunities, workshops and guest speakers.Appropriate engagement of Indigenous and non-traditional NRM groups would be highly regarded.
Please describe the community engagement and education activities proposed in this application.
Key Milestones / Activity / Expected Completion Date

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Activities and Budget

Requested funding must not exceed $10,000 per project per annum. Multiple year projects may be approved and a multiple year approach is encouraged where this will provide benefit to the outcomes achieved.

Project Activity / description / Units
(m/ha/hrs) each / Quantity / Time of year / Corangamite CMA contribution by year($)
(max. $10,000/yr) / Total project costs ($)
Year 1 / Year 2 (if applic)
Example: Fencing Standard / M / 1000 / Winter / July / $5000 / $5000
Example: Purchase tubestock / Each / 2000 / August / September / $2000 / $2000
TOTAL

Show the Nett total amount (excluding GST) that will be paid for each service / product. Where relevant, specify the quantity and rate used to calculate the costs.

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Monitoring, Evaluation and Reporting

Progress reports will be required to be submitted on a six monthly basis. A standard reporting proforma will be supplied by the CMA, and will be based on the management activities of the project. Reporting will include the need to provide photo point monitoring of on ground works.

Risk Assessment

Using the risk matrix below, please complete a risk assessment taking into consideration the environmental, economic and social impacts, including the OH& S requirements that your project may have.

Risk scenario / Likelihood / Consequence / Rank
Example:
Significant alterations to habitat lead to loss of habitat and changes in species diversity and abundance. / Very unlikely (1) / Moderate (3) / Overall rank using table below = Moderate Risk

Risk Ratings

Consequence / Insignificant
(1) / Minor
(2) / Moderate
(3) / Major
(4) / Catastrophic
(5)
Likelihood
Highly Likely (5) / H / H / E / E / E
Likely (4) / M / H / H / E / E
Moderately Likely (3) / L / M / H / E / E
Unlikely (2) / L / L / M / H / E
Very Unlikely (1) / L / L / M / H / H
Legend: / E - Extreme Risk / H - High Risk
M - Moderate Risk / L - Low Risk

Risk Ratings are calculated by using the original likelihood & consequences rounded averages

Permits and approvals

You must ensure that you apply for any permits or statutory approvals that are required for the activities proposed. Please list anypermits/approvals required for this project and whether they have been obtained as yet. If not, please provide an explanation.

Permit / Approval Required / Obtained yet? (Y/N) / If no, explanation:
Declaration
On behalf of the individual / group known as:
I / we declare that I / we have been consulted about this project and certify that the necessary approvals have been granted for it to proceed
Project Manager Signature:
Name:
Group president / secretary signature:
Position:
Name: / Date:

The project must be co-signed by the local land manager (for instance, Parks Victoria or Department of Environment, Land, Water and Planning).

Endorsement by Land Manager:

Officer Name: Position:
Organisation:
Signature:
Date:

Privacy

Personal information, supplied by you and/or contained herein is collected, stored and maintained for the purpose of facilitating and administrating this grant. This information maybe disclosed to relevant government organisations or other agencies for the sole purpose of administering the grant for which the information was collected. The information collected is not traded, sold, licensed nor used for commercial marketing purposes. You have the right of access to this information. Sites are to be made available for monitoring or demonstration purposes by Corangamite CMA staff.

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