Group details

Group/Organisation Name / Secretary
Contact Person / Contact Phone Number
Contact Email / Contact Mobile Number
Postal Address / ABN Number
Suburb / Post Code / Group Incorporation Number / VFF No.
Is your group Registered for GST? Yes No
Is your group Insured? Yes No
In order to receive a PPWCMA Community Grant, your group will need to be covered by public liability insurance of $10M and personal accident insurance (or to be auspiced by a group that carries such insurance), or be a current member of the FTLA. If your application is successful, you will need to provide a photocopy of your certificate of currency. A certificate of currency is a summary of the insurance cover showing relevant details. The Certificate is available upon request from the insurer or broker and is common in the insurance industry (your insurer/broker should not charge you for a Certificate of Currency). You must ensure that the Certificate is stamped and signed by the insurer and that it shows the expiry date. See also ‘Incorporation and insurance’ in the PPWCMA Community Grants Guidelines 2013/14. Current FTLA membership will be confirmed by the PPWCMA

Which type(s) of grant are you applying for?

Please complete the relevant types. Be aware that if you are successful in applying for a Type A grant, over $10,000 you will not receive a Type B grant.
Type of grant(s) requested / Amount (ex. GST)
A –Project Grant(max $20,000 ex. GST) / $
B – Group Support/Start-up Grant ($500 - $1000 ex. GST) / $
Total / $
Note: If you are applying ONLY for a Group Support or Start-up grant you will need to fill in form ‘C’ only.

Project Manager Details (Responsible for project delivery and reporting)

Name:
Postal Address:
Phone Number: / Mobile:
Email: / Fax:

Previous Funding

Do you have carry over PPWCMA grantfunds from the 12/13 or any previous years? Yes No
If yes, what is the amount of funding left over? $
Note: Groups have until the 30November 2013 to complete and report their 2012/13 PPWCMA Community Grant project. If your project is not going to be completed by this date, please contact the Environmental Project Coordinator to discuss before submitting this grant application.

Other Funding

Have applied for, funding fromanother source for this project? Yes No
If yes, please detail the fund source .

About your project

Project Title: (max 10 words)
Project Partners.
List all partners in the project (other community groups, local council, adjoining CMA etc)
Land ownership
Who is the owner or land manager for your proposed project site? / Approx % PrivateLand / Approx % PublicLand
Where is the project site?Please describe the location
Melways Reference
Vic Roads Directory Reference
Nearest Town
Local Council
In line with State Government requirements, the PPWCMA requires all groups applying for Grants for on ground works to map the proposed project site. One method for this is to use the Department of Environment and Primary Industries free online mapping software (Mapshare). The guidelines and link to the Mapshare website can be found on the PPWCMA website ( & grants>reporting requirements>DSE Interactive Map Guidelines). Google Earth or other mapping software is also acceptable.
Aerial photographs with the Group name, project title, project sites and activities clearly marked are also acceptable and should be posted to:
Community Grants
Port Phillip & Westernport CMA
Lvl 1 454-472 Nepean Hwy, Frankston 3199
Have you mapped your proposed project site and submitted it to the PPWCMA? Yes No

Project Description

Provide a description of your project. Describe what you are aiming to achieve and how you go about it. Remember to include the: asset and threats, public benefit, on ground works, capacity and engagement building, and examples of innovation (or any combination of these) that you plan to deliver. Refer to the frequently asked questions for more information.

Delivery Method

Provide a description of the activities and their components that you will undertake to complete your project. The activities and components listed here should link directly to the budget.

Project Strategic Alignment

Links with local and Regional strategies and plans including: Landcare group/network plan; Local council plan; Regional Catchment Strategy; other relevant plans.
Title and short description of strategy/plan / How does this project link to the strategy/plan?

Outputs

What are the outputs you expect your project to achieve? If your application is successful, your agreement will include a list of agreed outputs which you will need to report back on when your project is finished.
On Ground Outputs / Quantity
Revegetate with indigenous vegetation
(Hectares) / Wetlands (in absence of remnant vegetation)
Wetlands (next to or within remnant vegetation)
Within Coastal zones (in absence of remnant vegetation)
Within Coastal zones (next to or within remnant vegetation)
Other terrestrial zones (in absence of remnant vegetation)
Other terrestrial zones (next to or within remnant vegetation)
Managed for natural regeneration
(Hectares) / Within Coastal zones
Within Riparian zones
Wetland
Other terrestrial zones
Fence Remnant Vegetation
(Hectares) / Within Coastal zones,
Other Terrestrial Zones
Grazing regime change / Grazed as required for Natural Resource Management outcomes
Grazing removed for at least 5 years
Other
Land treated under soil conservation practices
(Hectares) / Activities include liming, improved grazing and crop management, improved cultivation practices including no till, stubble treatments, rotational grazing management
Pest treatment / Regionally Controlled Weeds / Area treated (Hectares)
Area managed (Hectares)
Length of waterway or land treated (Km)
Number of sites treated
Regionally Prohibited Weeds / Area treated (Hectares)
Area managed (Hectares)
Length of waterway or land treated (Km)
Number of sites treated
Other weeds / Area treated (Hectares)
Area managed (Hectares)
Length of waterway or land treated (Km)
Number of sites treated
Pest Animals (detail species in project description) / Area treated (Hectares)
Area managed (Hectares)
Length of waterway or land treated (Km)
Number of sites treated
Capacity Building Outputs / Quantity
Awareness raising / Number of Events
Number of participants
Skills and Training / Number of events held
Number of local coordinators & facilitators participating
Number of participants
Community Groups Supported / Number of groups supported,
Number of individuals supported,
Number of meetings held,
Number of new groups established,
Number of participants
Partnership Building / Number of Agreements
Number of MOUs
Number of Waterwatch,
Number of Other
Community group publicity material / Number of factsheets
Number of news articles
Number of newsletters
Number of pamphlets
Number of TV interviews
Increased human capacity / No. of projects/activities/events - Community groups
No. of projects/activities/events - Individuals and landholders
No. of projects/activities/events - Regional agencies
Planning Outputs
Conservation Agreements/Stewardship Agreement
Conservation covenant, Permanent protection agreement, Riparian management agreements, Whole Farm Plan, Fixed term agreement, Conservation agreement, Permanent protection / Area covered (Hectares)
Number of agreements established
Management Plan Established / Area managed (Hectares)
Number of agreements
Property management plans (including Environmental Management System or EMS) / E-Farmer / Area covered by new plans
Area covered by implemented property plans
EMAP / Area covered by new plans
Area covered by implemented property plans
EMS Implemented (ISO 14001 or compatible) / Area covered by new plans
Area covered by implemented property plans
EMS self-assessments & action plans complete / Area covered by new plans
Area covered by implemented property plans
EMS self-assessments complete / Area covered by new plans
Area covered by implemented property plans
Whole farm plan – dryland / Area covered by new plans
Area covered by implemented property plans

Risk Assessment

What are the major foreseeable risks facing your project, and what measures do you have in place to reduce their impact? Refer to the risk assessment table belowand page 5 of the guidelines to determine the rating.
Risk/Threat Description
Describe the threat/risk, its sources and impacts / Likelihood*
Rare, Unlikely, possible, likely, almost certain / Consequence*
insignificant, minor, moderate, major, critical / Rating
Low, Medium, high, severe / Current Controls/Contingency
Describe what you will do to mitigate the threat/risk, source or impact to an acceptable level
CONSEQUENCE
Insignificant / Minor / Moderate / Major / Critical
LIKELIHOOD / Almost Certain / Low / Medium / High / Severe / Severe
Likely / Low / Medium / Medium / High / Severe
Possible / Low / Low / Medium / High / Severe
Unlikely / Low / Low / Low / Medium / High
Rare / Low / Low / Low / Medium / High

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Budget

What are the budget requirements for your project? Cash contribution could be from project partners, landholder cost share, other funding. In-kind contributions can be volunteer labour ($30/hr), vehicle/machinery usage. Projects seeking more than $10,000 must include at least 50% ofexpenditure for on-ground works. Add rows as necessary.
GST: Do not include GST in project budgets in your applications. All costs should be exclusive of GST. If your group or organisation is registered to collect GST, the required 10% will be added to the allocated funds.
Activity
(As per your Delivery Method page 3) / Components
(As per your Delivery Method page 3) / Unit and unit price / Quantity / Total Cost for activity / PPWCMA Grant funding sought / Other Cash Contribution (source and amount) / In-kind contribution
Revegetation / Site preparation by contractor ripping / $55/Hour / 100 hours / $5,500 / $3,000 / Local Government Grant - $2,500 / 0
Revegetation / Planting / $30/hr / 100 hours / $3,000 / $0 / $0 / $3,000
Total
Are you applying for a B-Group support /Start-up grant? If yes, briefly describe below what you will do with the grant if successful. (refer to page 5 of the guidelines)
Note: - If you are secure a project grant greater than $10,000 you are ineligible for a Group support-Grant
- If you are completing this form, you do not need to complete a separate form for the B grants.
- If you are applying for a Start-up grant proof of incorporation must be provided before funds are paid

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For more information . Ph: 03 8781 7900

Consultation, permits, approvals and compliance with legislation

Native vegetation means plants that are occur naturally in Victoria, including trees, shrubs, herbs and grasses. This includes areas of bushland with trees, scattered paddock trees, and treeless areas of scrub or grassland. In fact, some of the most rare or threatened vegetation types do not include trees at all, such as native grasslands, many wetlands and alpine communities. Sometimes Landcare projects include works that may result in the removal, destruction or lopping of native vegetation (such as warren or burrow ripping). If you think your project may impact on native vegetation, you should take the following steps.
Consider whether there are other options that would avoid the need to remove, destroy or impact native vegetation (but note that pest control methods involving fumigation, explosives and firearms are not eligible for funding).
If impacts on native vegetation can’t be avoided, you may need to seek permission before you can proceed.
To seek a permit you will need to contact your local council. In some cases written agreement from a relevant Department of Environment and Primary Industries officer would allow removal of native vegetation beyond these levels, but this would require further investigation of any flora and fauna issues. Your first point of contact should be your local council.
If you are not sure what zone you are in, contact your local council planning department.
If exemptions apply (i.e. if you don’t need a permit), you will need to show that this is the case by providing a map or a copy of correspondence. It is recommended that landholders keep a record of clearing under any exemption in the event that the clearing is contested.
For full details on farming and native vegetation permit requirements, go to
Land tenure
Are the proposed works on crown land e.g. water frontages or unused roads? Are they on public land or private land?
Public Private Mix of public and private
Land Manager / Local Council Endorsement
Permission must be sought from the land manager if the proposed works are on public land. Permission also needs to be obtained from your local council before commencing any on-ground works on unused roads.
Name of person contacted:Position:
Organisation:Phone:
Email:Mobile:

Invasive Plants and Animals

If your project involves control of Invasive Plants and Animals, have you sought advice from your local council or DEPI (contact details are in the guidelines)? Yes No
Name of person contacted:
Provide a brief summary of the issues discussed:
If you haven’t sought advice, why?

Cultural Heritage

Does your project involve disturbance of earth? Yes No
If yes, have you checked with Aboriginal Affairs Victoria (AAV) to find out whether your project site is within an area known to contain a site of cultural significance? Yes No
Name of person contacted:
If yes, please attach documentation provided by AAV. If no, you will need to obtain documentation from AAV if your application is successful before your agreement will be signed.
Please provide:
  • a description of the works, including site preparation methods (i.e. how the earth will be disturbed, e.g. rip lines for native vegetation AND
  • GPS coordinates of the boundary of the site and an aerial photo marking the specific location of the works project, including known roads, directional arrow, scale and legend
  • OR a map of the site including all this information from Mapshare The guidelines and link to the Mapshare website can be found on the PPWCMA website ( & grants>reporting requirements>DSE Interactive Map Guidelines)
Occupational Health and Safety
You need to make sure you have a safe system of work in place for your project to protect the health and safety of your group, volunteers and anyone else on your project site.
You can find resources on OHS tailored to community groups on the Victorian Landcare Gateway:
Does your group have appropriate OHS procedures in place? YesNo

Reporting requirements

Groups receiving a PPWCMA Community Grant will be required to lodge a progress report 6 months from being awarded the grant (approx May 2014) and a Final Report by the 30 November 2014. Groups will need to report on the achievement of agreed activities and outputs, including a map/spatial information for any on-ground works undertaken as documented in the agreement.
Have you read and do you understand the reporting requirements expected if you are successful in obtaining a project grant?
YesNo

Group acknowledgement

On behalf of the group we understand that this is an expression of interest only and that final project approval will be subject to funding availability and project suitability. Assistance is not availablefor work completed prior to project approval and the signing of an agreement.
If submitting this form electronically, please type your name in CAPITALS in the signature box and it will deemed that you agree to the terms above.
Project Manager Signature:
Name:Date:
Office bearer signature:
Name:Date:
Position:
Successful groups will be required to enter into a signed agreement with the CMA that will provide a summary of agreed works, timeframes and reporting requirements. This agreement will be a legal document.
Privacy
Personal information supplied by you and/or contained herein is collected, stored and maintained for the purpose of facilitating and administrating this grant process. 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 to access to this information. Sites are to be made available for auditing, monitoring or demonstration purposes at the request of CMA staff.

Submission Checklist

Have you:
Completed all sections of the application form?
Mapped the project site?
Obtained all the necessary permits?
Obtained all the necessary signatures?
Read, understood and attached the Insurance, OH&S, and Cultural Heritage Sensitivity requirements?
Read and understood the reporting requirements, including the mandatory spatial data mapping?
Double checked your budget figures?
Attached copies of all relevant documentation?
Please send your completed application to:
Community Grants
Port Phillip & Westernport CMA
Lvl 1, Landmark Corporate Centre
454 – 472 Nepean Hwy
Frankston Victoria 3199 / Or email the completed form and documents to:

REMEMBER: APPLICATIONS CLOSE 25thOCTOBER 2013

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For more information . Ph: 03 8781 7900