Open grant application form

Please refer to the Woolworths Fresh Food Future ‘Open Grants Application Guidelines and Assessment Criteria’ before completing this form. The Application Guidelines and Assessment criteria are available on the Landcare Australia website -

Project title

Title:
Total funding sought: / Application Date:
Project Start Date: / Project End Date:

Your details

Name:
Name of group or organisation (if applicable)
Postal address:
Town/Suburb: / State: / Postcode:
Email address:
Daytime phone number:
Mobile phone number:
Fax number:
Website address
Preferred method of contact: / Email Mobile Daytime phone Mail

Location

/ CMA or NRM region:
If unknown, you can find it via the following website link
NRM region locality search
/ Location of project site/s:
/ Latitude: / Longitude:
/ Nearest town / Site postcode/s
/ Who owns the site/s: / Public Private Other (please specify):
/ Approximate size of project: / Hectares (ha)

GST status, ABN and insurance

/ Is your organisation registered for GST ? / Yes No
/ Australian Business Number (ABN):

If your group/organisation is not registered for GST, but is affiliated with a group that is registered for GST and will accept responsibility for administering the financial aspects of your grant, please provide details:

/ Name of affiliated group: / ABN
/ Are they registered for GST? / Yes No

National Landcare Directory

If you are a Landcare or Community group, we request that you register on the National Landcare Directory via the following link: National Landcare Directory Registration

Is your group registered on the National Landcare Directory / Yes No

Brief overview of your group or organisation

Project Description

Write a brief description of your project. Provide some information on the context of your project, what issues will be addressed, outline what you aim to achieve and how you will do so. This summary must communicate the key points for explaining the importance of your project to others. Use as much space as necessary.

Project significance

Please briefly describe why this project is important

Project outcomes and activities

Please describe what you aim to achieve and the planned activities in the project. Provide as much information as necessary so that we can clearly understand how your project will progress, including how addressing water use efficiency or improved nutrient management will contribute to increased productivity and a reduction in the carbon footprint. (eg identify appropriate equipment needed, purchase and install equipment, take samples to measure growth etc.).

Your project timetable: briefly tell us the project’s milestones and planned achievementdates.

Please describe the milestones and activities you will undertake to achieve the milestones. Include additional rows as required.

Milestone name

/ Activities undertaken to achieve the milestone / Achievement date

1

/ /

2

/ /

3

/ / /

4

/ / /

Assessment criteria

Please describe how this project will address the ‘Woolworths Fresh Food Future Open Grant Assessment Criteria’ available for download from the same location as this application form.Please include the estimated improvement targeted by the project (eg; reduced water use or fertiliser use by 5% or increased water use efficiency by Xkg/ha/mm; Xkg/ML, reduced energy use by 5% etc.)

Collaboration

Please briefly describe any individuals, groups or organisations that will collaborate on this project and how they will contribute, including the technical support available to the project.

Monitoring results and measuring success

Please list what you will monitor and how you will calculate the project’s success in achieving the targeted improvements (eg before, during and after photos, plant survival rate, biomass cuts, yield, no. of landholders participating).

Project benefits. Please explain how this project will:

Benefit other farmers or the community.
Share the results with other farmers and
Acknowledge the support of Woolworths

Project budget

Please list the required project funding and resources you seek (eg funding and in-kind support for items such as labour costs, machinery hire, fencing materials)
IMPORTANT NOTE:
These budget amounts must be GSTinclusive.
Item
eg Soil analyses,
Labour for installation of fencing / Description
eg Xm Poly pipe @ $3.50/m
2 people x 3 day @ $30/hr / Funding amount
(incl GST)
$ / In-kind contributions$
Total (amount in whole dollars only, incl. GST):

Visual records

In addition to the measurements described above, visual records are very important to demonstrate the success of projects. Please list any photos or video records that you plan to take during the project. Describe what, when and how you plan to record progress, success and events.If required, Landcare Australia can provide you with a brief guide to assist taking good project photos.

Permits and approvals

Do you need permits or approvals to undertake the various project activities? / Yes No
If yes, issuing authority:
Status: / Granted and attached / Application made on / /
Not granted / Yet to be sought

Authority to submit

I declare that:

The information given on this form is complete and correct.

Funds will be used only for the project described on this application.

If successful, I agree to provide a written report within 1 month of completing the project, and any photos or video footage as part of the feedback process, for the use of Landcare Australia Limited.

I consent to the release of project information in this application for promotional and evaluation purposes relevant to Landcare Australia Limited.

Group or Organisation representative
Project Title:
Name:
Position:
Signature:
Date:
Phone:

Lodge your application

Complete the application form and save it as a Word document with your group or organisation at the end, eg;

‘Woolworths Open Grant Application Big River.doc’ or

‘Woolworths Open Grant Application WFS.doc’

If you are able to email your application with a scanned signature, there is no need to also send a copy in the post or by fax.

If you are unable to scan your signature, simply fax or post only this signature page, ensuring that you have entered the correct Project Title in the signature box above. Please include a note specifying that you have sent an earlier copy via email. Please email, fax or post your completed application to:

Email:
Phone: 02 9412 1040
Fax: 02 9412 1060 / Postal Address
Woolworths Fresh Food Future Open Grants,
Landcare Australia Limited,
Level 1, 6 Help St,
Chatswood NSW 2067

Thank you for your time in completing this application.

Please return to:

Enquiries: (02) 9412 1040

Landcare Australia Limited

Level 1, 6 Help St

Chatswood NSW 2067

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