Application Form: word version
Please complete the form below to apply for a Northern Gulf Community NRM Grant. Before making an application please read the grant guidelines on the Northern Gulf Facebook or Website. Applications must be submitted by 5.00pm Friday 10 February 2017.
Where to get help?
Northern Gulf Resource Management Group can offer technical advice for your project ideas and identify possible partnerships for delivery. We strongly recommend that you contact a Northern Gulf Resource Management Group staff member to discuss your project and/or arrange a site visit as early as possible. See Attachment 1 for staff contact details. You can also contact the Northern Gulf Resource Management Group NRM office on (07) 4092 1088 or email or
Section 1 – Applicant Details
This application must be completed by an organisation which is a legal entity able to enter into a funding agreement with Northern Gulf Resource Management Group NRM.
If your community group is not a legal entity (i.e. you are not incorporated and do not have an ABN), you will need a Sponsor organisation to submit a proposal on your behalf. If you require a Sponsor, please add their details to Section 9.
Section 1.1 - Your Organisation Details
Trading name of Community GroupLegal name of Community Group
ABN
Incorporation number
Official Contact Person
Role in group
Phone / Mobile
Email / Fax
Postal Address
In the box below please write the name of the best person to contact about your project.
Community Group Project ManagerPhone / Mobile
Email / Fax
Section 2 – Project Name
Project NameSection 3 - Project Location
Which is the nearest town to your project location?If your application is successful, you will be required to provide information on the specific locations of your project through Northern Gulf Resource Management Group officer’s support.
Section 4 - Your Project Proposal
Section 4.1 Background
This section is not mandatory but provides an opportunity for you tell the story of the history of your project. How did this project come about? Is there contextual information you think is important for the assessors? (350-word limit)Section 4.2 Description
Tell us about your project, what you hope to achieve and how you plan to go about it.Please make sure that you provide enough detail, to enable the assessors to clearly understand the value of your project and how you are planning to go about it. (700-word limit)
Section 4.3 Assessment Criteria
Describe how your project meets the following assessment criteria (350-word limit per criteria).
Addressing PrioritiesExplain how your project delivers on the objectives of the National Landcare Program and/or Local priorities (for more information go to the FAQ factsheet)
Group Capacity
Tell us about your group’s capacity to successfully deliver the project.
Partnerships
Explain how your project provides opportunities for developing or enhancing partnership with others.
Traditional Owner Engagement
Explain how you have, or will, involve Traditional Owners in the planning and implementation of your project.
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Section 4.4 Project Activities (task schedule)
In this section set out the activities you are going to do in the order you are going to do them. This will show the assessment panel that you have clearly thought about the steps to achieve good project outcomes. If your application is successful, your project reporting will need to demonstrate that you have actually done these things.
Complete the table below to create a Task Schedule. If your application is successful, the Task Schedule will form part of the contracted activities within the grant agreement.
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Task number / Title / Description / Start date / End date1
2
3
4
5
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Section 4.5 Project Future
Will your project need future maintenance beyond the project time frame? If so, how will this be done? (350-word limit)Section 5 - Insurance
It is a legal requirement that your organisation (or Sponsor - see Section 9) have public liability cover to the amount of $10 million and a certificate of currency for worker’s compensation (WorkCover). If successful, you will need to provide a copy of this documentation.
Does your organisation have appropriate insurance?Yes
No
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Section 6 – Risk Assessment
Northern Gulf Resource Management Group is obligated to provide and maintain, a workplace that is safe and without risk to health and the environment. This obligation flows through to all subcontractors, including grant recipients.
Applicants must exercise all necessary precautions for the health and safety of all persons including employees and members of the public. Therefore, all applicants need to identify Occupational Health and Safety (OHS) risks and describe how they will reduce those risks.
Please add your risks to the table below.
(Description) / Likelihood
(select from options below) / Consequence
(select from options below) / What do you plan to do about it?
(Mitigation)
Likelihood = Rare, Unlikely, Possible, Likely, Almost Certain.
Consequence = Insignificant, Minor, Moderate, Major, Catastrophic.
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Section 7 - Project Budget
Before preparing a project budget please read the ‘funding limit’ and ‘devolvement of funds’ sections of the Grant Guidelines. The budget template below is designed to help you to work out your total project costs and to guide expenditure. An Example Budget is provided at Attachment 2.
Please prepare a project budget using the table below.
· Expense types are provided as examples, please adjust them to suit your project.
· All figures must be written as GST exclusive.
· Round up all figures to the nearest dollar.
· If you have obtained quotes, please write 'based on quote' in the description.
In-kind contributions are not mandatory however they will be considered when assessing the “value for money” criteria.
Project Budget
Expense Types / Expense description / Grant $ requested(GST exclusive) / In-kind contribution
Labour
Equipment
Consumables/Materials
Meetings/Workshops
Training
Education and awareness activities
Other
Other
Other
Sub-Total (not including admin)
Administration support (up to 10% of the project budget)
Total Grant $ Requested (GST exclusive)
Would you like to provide any further comment about how your project demonstrates value for money?
Section 9 - Sponsor Organisation Details
This section is for use only by unincorporated groups applying for funding through a Sponsor.
Do you need a Sponsor?
To enter into a funding agreement your organisation must be a legal entity. If your community group is not a legal entity (i.e. you are not incorporated and do not have an ABN) you can still make an application but you will need a Sponsor. The Sponsor will take full legal and financial accountability of the proposed project including signing the grant funding agreement and/or any declarations. If successful, the application will form the basis of the legal agreement between the Sponsor and Northern Gulf Resource Management Group. Please ensure the Sponsor is fully aware of the application details.
Trading name of SponsorLegal name of Sponsor
Sponsor ABN
Sponsor incorporation number
Sponsor official contact name
Role in organisation
Phone / Mobile
Email / Fax
Postal Address
Section 10 - Declarations
I understand that:
· While all care will be undertaken by Northern Gulf Resource Management Group in receiving and processing applications, we cannot be held responsible for applications that are not received or incomplete.
· Decisions made by Northern Gulf Resource Management Group regarding approval of this application will be final, however feedback will be offered to unsuccessful applicants.
· Submission of this application does not guarantee funding.
· The group (or sponsor) cannot be funded for activities that have commenced prior to signing an agreement with Northern Gulf Resource Management Group.
I understand that if this application is successful:
· The group (or sponsor) will enter into an agreement with Northern Gulf Resource Management Group, which ensures that the group will use their best endeavours to complete the activities outlined in this application by the date indicated.
· The group (or sponsor) will be paid the total figure of the grant agreed in progress payments over the project period.
· A Northern Gulf Resource Management Group employee may request a meeting with the applicant for the purposes of project briefing.
· The Group may be required to provide further information including, but not limited to, mapping information, risk assessment and insurance documentation and before and after photos for on-ground works.
I declare that:
· The group have not received funding from other sources for the project activities described in this application.
· To the best of my knowledge, the information in this application is complete and accurate.
Sign below to acknowledge the above declarationsName of the person making the declarations:
Date:
Section 6 – Submitting your application
Thank you for applying to Northern Gulf Resource Management Group for a Northern Gulf Community NRM Grant.
Please keep one copy of your application for your records and another to submit.
You can submit your application to:
Email:
Post: Community Grants
Northern Gulf Resource Management Group
PO Box 2077
Mareeba QLD 4880
We will send you confirmation that we have received your application via mail or email. If you do not receive a confirmation within 5 working days of sending us your application, please call our office on (07) 4092 1088.
After the closing date of 5.00pm Friday 10 February 2017, all applications will be checked for completion and provided to the assessment panel. Northern Gulf Resource Management Group may contact your group for extra information following submission to assist with project assessments.
Northern Gulf Resource Management Group anticipates that successful grants will be announced on Friday 10 March 2017.
Attachment 1
Your local Northern Gulf Resource Management Group staff member contact details:
Ø Allan Holmes, Executive Coordinator
P: (07) 4092 1088
M: 0498 977 632
E:
Ø Vickie Mylrea, Projects/ Services Manager
P: (07) 4092 1088
M: 0429 067 338
E:
Ø Peter Harrison, Mapping Coordinator
P: (07) 4092 1088
M: 0417 538 142
E:
Ø Paula Ransom, Project Support
P: (07) 4062 1330
E:
Ø Michael Anthony, Wildlife Officer
P: (07) 4062 1330
M: 0499 057 706
E:
Attachment 2
EXAMPLE Project Budget
Expense Type / Expense description / Grant $ requested(GST exclusive) / In-kind contribution
Labour / - 120 hours paid labour @ $35/hr
- 150 Volunteer labour @ $30/hr / $4,200 / $4,500
Equipment / - Materials for pig traps
- Spray pack / $400
$400 / $250
Consumables/Materials / - Protective gear
- Herbicide / $450
$200
Meetings/Workshops / - Field Tour – bus hire
- Registered signage
- Morning tea - $10 per head x 15 people / $500
$50 / $150
Training / Weed Identification training 3 people @$70.00 each. / $210
Education and awareness activities / Developing and printing of brochures (x2000) / $200 / $500
Other
Sub-Total (not including admin) / $6,610 / $5,400
Administration support (up to 10% of the project budget) / $661
Total Grant $ Requested (GST exclusive) / $7,271 / $5,400
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