Estuary Management Program

Application form for financial assistance 2013–14

Closing date: 5pm 14 February 2013

Refer to the Coastal and Estuary Management Programs Grant Application Guidelines 2013–14for help in filling out this application form. The guidelines are available onthe Office of Environment and Heritage (OEH) website at

To complete this form electronically, pleasetype in the shaded areas, shown as °°°°°; and click in the shaded boxes  where a cross in the box is equivalent to a tick.

Applicant’s details

1.Applicant’sname, contact details and project partners

Applicant:

Contact details

Name:
Position:
Address:
Phone/Mobile: / Fax:
Email:

Project partner(s)

Attach a letter of support from your partner(s), which also outlines their financial commitment to the project.

Project partner(s):

Project details

2.Project name (max 80 characters)

3.Project category

This relates to the funding priorities outlined in the grant application guidelines – select one only

Prepare Coastal Zone Management Plan (CZMP) / Restoration activities (in a CZMP)
Restoration activities (not ina CZMP)
Technical study to inform preparation of a CZMP
Review management plan / Management tools (in a CZMP)
Management tools (not in a CZMP)
Evaluate implementation of plan

4.Project activity(select one only)

Prepare management plan / Environmental restoration/revegetation
Review management plan / Erosion control works
Technical study / Education
Estuary health assessment / Investigation/planning/design
Monitoring / Stormwater management
Other (specify): / Plan implementation evaluation and report

5.Project timeframe

Please be realistic about the completion date, as this will be used to set the term of your funding agreement if you are offered a grant.

Proposed commencement date (not before 1 July 2013):
Proposed completion date
(project duration cannot exceed 24 months):

6.Project location

Enter location description and attach a locality diagram or map. Where possible, include town, latitude, longitude, nearby road, beach or other notable landmark.

If the project location falls across more than one local government area (LGA), catchment management authority (CMA) region, electorate boundary or catchment, please identify the primary one first.

LGA[*] / CMA region / State electorate(s) / Catchment
(if applicable)

7.Budget overview

More details must be provided in the preliminary workplan at Q17.

Financial year / Applicant’s contribution
(excluding GST) / Partner contribution
(excluding GST) / Grant amount sought
(excluding GST) / Total amount
(excluding GST) / Funding level sought
(up to 50%)
2013–14 / $ / $ / $ / $ / %
2014–15 / $ / $ / $ / $

8.Project summary

Please provide a brief project overview, including location and the issue that the project will address. This will be used for promotional purposes (max 150 words).

9.Other grants at this location

Have you received any previous funding for projects at this location? YesNo

If Yes, please provide details below:

Project name / Funding source (e.g. State Govt, Commonwealth Govt) / Program name / Year of offer / Amount / Completion/ expected completion date
$
$

10.Other funding sources

Do you have any current or planned proposals to other funding programs for this project or components of this project? Yes No

If Yes, please provide details below.

11.Background of issue

Please specify why this issue is a problem.

12.Is this project of regional or state significance? Yes No

If Yes, please state why, including if there is an immediate threat.

13.Why is funding required?

Please specify why this project could not proceed without funding.

14.Project objective

Please specify what you plan to achieve with this project.

15.Project outcomes

Please briefly outline the result, impact or benefits (including any environmental benefits)of the project such as its success.Note:If your application is successful you will need to report against these outcomes in your final report.

16.Project outputs

Please provide measures of the project activities. These should be tangible and quantifiable.
Note:If successful, you will need to report against these in your milestone and final reports.

17.Preliminary workplan

You must attach a preliminary work plan in Microsoft Excel format. The template for the plan is available at Please be realistic about the dates and costs you provide in your preliminary work plan and ensure that they match the completion date provided under Question 5.

18.How does the project meet the Estuary Management Program’s objectives and priorities?

19.Outline your capacity to deliver the project

Look at your past grants management history, available resources and the proposed timeframe and consider whether it is realistic based on completion of prerequisite consultant briefs, preconstruction work or approvals.

20.Do you agree to enter into, and be bound by, the conditions in a funding agreement(as outlined in the grant application guidelines)? Yes No

21.Have you discussed the project detailswith a relevant OEHofficer? Yes NoHas technical advice been provided by a relevant OEH officer? Yes No

If yes, provide the name of the OEH officer, and the nature of advice provided.

22.Is the project part of a recommended action in a coastal, coastal zone or estuarymanagement plan? Yes No

If yes, provide details, including relative priority.If no, explain how the need for this project was established.

23.Is the project supported by the relevant CMA? Yes No

If yes, provide brief details.

24.To what level is the project supported by the community?

25.Has the proposed project been subject to public exhibition or consultativeprocesses?

Yes No

If yes, provide details.

26.Are the works proposed on:

public land privately-owned land N/A

Provide details (if applicable).

27.Do the proposed works have the landowner’s consent? Yes No

Provide details (if applicable).

28.Have the proposed works been approved in accordance with the Environmental Planning and Assessment Act 1979? Yes No

If yes, provide details; if no, briefly outline timetable for obtaining approval.

29.Have all necessary statutory approvals/licences been acquired to facilitate the works? Yes No

If yes, provide details; if no, outline timetable for obtaining approvals.

30.Have detailed designs and associated specifications for theproposed works already been prepared in accordance with best practice guidelinesand relevant standards?

Yes No

If yes, provide details.

31.Are there any outstanding legal/social/environmental or culturalheritage issues preventing the proposed works from proceeding? Yes No

If yes, provide details and anticipated time to resolve them.

32.Will the project be undertaken by a contract after calling for competitive tenders? YesNo

If no, youmust attach a separate page justifying this.

33.Is the applicant able to fundtheirshare of the required project funds?

Yes No

If no, youmayapply for special consideration byattaching a separate page outlining your case.

Authorisation

Provide the name of a senior officer in your organisation, with appropriate delegation, who has authorised the submission of this project and has the delegation to authorise the commitment of the resources and expenditure required to deliver this project.Note: a signature is not required.

Name:
Position:
Phone no:
Email:
Date:

Lodging applications

Electronic applications are preferred and can be lodged at . Alternatively,if you are unable to email your application, you maypost itto:

Grants Program Coordinator
Waters, Wetlands and Coast Division
Office of Environment and Heritage
PO Box 3720 PARRAMATTA NSW 2124

Please do not email and post your application.

Before submitting your application, please use the checklist overleaf to make sure that you have included all the necessary information.

Applications must be submitted by 5 pm,14 February 2013.

Checklist

Please ensure you:

read the Coastal and Estuary Management Programs Grant Application Guidelines 2013–14

submit one application per project

submit your application in Microsoft Word document format. Other document types will not be accepted

answer all the questions in the application

type only in the spaces provided in the application form

manually spell check your application (the Microsoft Word Spelling and Grammar function is disabled in thisform)

enter the state(not federal) electorate(s) at Q6

enter monetary amounts in full e.g. $10,000 not $10k

check the budget amounts outlined in your attached preliminary work plan are consistent with the budget overview at Q7

have your application authorised by the appropriately delegated person (note: signature not required)

attach the additional information required, if you have answered ‘No’ to Q32 or 33

attach your preliminary workplan (required at Q17) in Microsoft Excel format

attach a letter of support from your project partner(s),if applicable

only include one application per document

include your organisation’s name,then project name in the subject line of your email when lodging the application (e.g. XX Council – XX CoastalZone Management Plan).

submit your application by the closing date– 5 pm 14 February 2013.

Office of Environment and Heritage

Email:

Website:

OEH 2012/0973 December2012

Application form for financial assistance 2013–14Page 1 of 8

[*] LGA, CMA region, state electorate and catchment information is required for program reporting purposes only.