Trust Admin Use Only / 2011/E / / Organisation Y / N / Proof of non-profit status Y / N
(if applicable)

ENVIRONMENTAL TRUST

Environmental Education Program Expression of Interest Form

Closing Date: 5pm Thursday 21 April 2011

General information

Please answer every question. Where a question does not apply to your proposal, write ‘not applicable’ or preferably briefly explain why. This EOI is set at four pages in length.

Section A – registration and administration
Name of Organisation
A1 / Program area
What program are you applying to? / State or Local Government / OR / Community
A2 / Project title (maximum of 68 characters including spaces)
A3 / Project category - what is the main focus of this project? Select only ONE box from the following choices
Education program targeting community / Education program targeting industry
Education program targeting government / Educational resource or curriculum development
A4 / Funding level - please indicate the level of funding you will seek from the Environmental Trust
(Select only ONE box)
$5,000 to $15,000
/ $15,001 to $25,000
/ $25,001 to $50,000
/ $50,001 to $75,000
/ $75,001 to $100,000
A5 / Time frame - your project cannot start before 1 February 2012 but must start before 30 June 2012
Proposed commencement date / Proposed completion date
(maximum 3 years duration)
A6 / Organisation’s details
Name of organisation
What is your ABN? / Registered for GST? / Yes or No
Postal address
Suburb / State / Postcode
A7 / Contact for correspondence - If University; provide Administration Office contact
Title / First Name / Surname
Position / Daytime phone / (0)
Fax / (0) / Email
A8 / Contact details for Project Manager (if same as the contact for correspondence, tick the box)
Title / First Name / Surname
Position / Daytime phone / (0)
Fax / (0) / Email

1 Environmental Education Program 2011 – Expression of Interest

Section B - organisational structure

This section gives us important background information about the nature of your organisation and your organisation’s ability to manage your project. See page 1 of the Expression of Interest Guidelines for the eligibility of your organisation to apply for a grant.

B1 / What is the legal status of your organisation? (Select only ONE box)
State government / Local government
Community group * / Incorporated association
Company limited by guarantee / Other (please detail)

*if you are a community group and not incorporated, you will have to nominate a suitable organisation to administer your grant if you are successful.

If you are a state or local government organisation, proceed to Section C. All other organisations should complete the rest of this section.

B2 / Date of formation of your organisation / Registration no.
B3 / Office-bearers (if applicable)
Name / Position / Address
Are your office bearers: / ELECTED / APPOINTED
Is there a regular turnover of office bearers? / YES / NO
How many members are there in your organisation?
Can members of the public join your organisation? / YES / NO
Section C – project details
C1 / What is the environmental issue you are addressing, and how will your project contribute to improving this issue?
C2 / Location of your project/organisation. Please provide the latitude and longitude (this can be taken directly from a map or visit www.environment.gov.au/erin/ert for assistance with finding the location). See EOI guidelines for information.
Latitude °(degrees) ′(minutes) ″ (seconds) S
Longitude °(degrees) ′(minutes) ″ (seconds) E
C3 / Project description. Briefly describe the environmental education project you wish to conduct.
C4 / Project objectives. List your project objectives (maximum of six) - this is what you want to achieve, not what actions or activities you will do.
C5 / Who are the target audience(s) / participant(s) for your project and why have you chosen them?
C6 / What educational / community engagement methods will you use to engage / reach your target audience? (e.g. training program, workshops, educational resource)
C7 / Have you undertaken any research so far to see if similar programs/resources to the project you are proposing have been done? If yes, please explain what you have found.
C8 / How will you measure whether your project has met its objectives, and what are the indicators of success?
C9 / Project partners: Please provide an outline of your project partners. Include information on their roles and responsibilities in the project.
Name / Role/Responsibility
C10 / Please provide an indicative budget breakdown of the funding you are seeking from the Environmental Trust. Refer back to Question A4 for funding level.
Expenditure item / Notional $
$
$
$
$
$
$
$
TOTAL / $
Section D - authorisation
Person authorising submission of expression of interest
Name:
Position in organisation:
Daytime phone: / (0) / Date:

DECCW 2011/0227

Published March 2011

3 Environmental Education Program 2011 – Expression of Interest