Grant Application Form 2012-2013

Coastal Management Program

Application Form for Financial Assistance 2012-13

Closing date: 5pm,28 February 2012

You will need the Coastal and Estuary Management Programs Grant Application Guidelines 2012-13prepared by the Office of Environment and Heritage(OEH) to help you fill out this application form. These are available onOEH’s web site athttp://www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm.

To complete this form electronically, please select from the accompanying drop down list; type in the shaded areas shown as °°°°°; and click in the shaded boxes  where a cross in the box is equivalent to a tick.

Applicant details

1. Applicant’sName

Contact Details

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

1. Project Name (max 80 characters)

1. Project Category(relates to the funding priorities outlined in the grant application guidelines-select one only)

1. Project Activity(select one only)

1. Project Timeframe

Provide justification if the project is planned to go beyond 12 months (up to 18 months only).

1. Project Location
   Enter location description. Where possible, include: town, latitude, longitude, nearby road, beach or other notable landmarketc. Locality diagram may be attached:

If the project location falls across more than one LGA, CMA region, electorate or Catchment, please identify primary one first.

1. Budget Overview (more details must be provided in the preliminary workplan at Q17)

1. Project Summary(brief project overview, including location and issue the project will address. This will be used for promotional purposes –max 150 words):

1. Other Grants at this Location
   Have you received any previous funding for projects at this location?selectYesNo
   If Yes, please provide details below:

1. Other Funding Sources
   Do you have any current or planned proposals to other funding programs
   for this project or components of this project? selectYesNo
   If Yes, please provide details below:

1. Background of Issue (why it’s a problem)

1. Is this project of regional or state significance?selectYesNo
   If Yes, please state why, including if there is an immediate threat.

1. Why is funding required (why would this project not proceed without funding)?

1. Project Objective(what you plan to achieve)

1. Project Outcomes (the result, impact or benefits (including any environmental benefits)of the project i.e. its success) Note: if your application is successful you will need to report against these outcomes in your Final Report

1. Project Outputs(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

1. Preliminary WorkPlan

You must attach a preliminary work plan in Microsoft Excel format. The template for the plan is available athttp://www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm.

1. How does the project meet the Coastal Management Program’s objectives and priorities?

1. Outline your capacity to deliver the project (having regard to your past grants management history, available resources and the proposed timeframe and whether it is realistic based on completion of prerequisite consultant briefs, preconstruction work or approvals)

1. Does the applicant agree to enter into, and be bound by, the conditions
   in a Funding Agreement (as outlined in the grant application guidelines)?selectYesNo

1. Have you discussed the project detailswith a relevant OEHofficer?selectYesNo
   Has technical advice been provided by a relevant OEH officer?selectYesNo
   If yes, provide the name of OEH officer, and the nature of advice provided:

1. Is the project part of a recommended action in a coastal, coastal zone or
   estuarymanagement plan?selectYesNoN/A
   If yes, provide details, including relative priority. If no, explain how the need for this project was established:

1. Is the project supported by the relevant Catchment Management Authority?selectYesNo
   If yes, provide brief details:

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

1. Has the proposed project been subject to public exhibition or consultative
   processes? selectYesNoN/A
   If yes, provide details:

1. Are the works proposed on:

public land? privately owned land? N/A
Provide details (if applicable):

1. Do the proposed works have landowner’s consent?selectYesNoN/A

Provide details (if applicable):

1. Have the proposed works been approved in accordance with the
   Environmental Planning and Assessment Act 1979?selectYesNoN/A

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

1. Have all necessary statutory approvals/licences been acquired to
   facilitate the works?selectYesNoN/A
   If yes, provide details; if no, outline timetable for obtaining approvals:

1. Have detailed designs and associated specifications for theproposed works
   already been prepared in accordance with best practice guidelinesand
   relevant standards?selectYesNoN/A
   If yes, provide details:

1. Are there any outstanding legal/social/environmental or cultural
   heritage issues preventing the proposed works from proceeding?selectYesNoN/A
   If yes, provide details and anticipated time to resolve them:

1. Will the project be undertaken by contract after calling competitive tenders?selectYesNo
   If no, theapplicantmust attach a separate page justifying this.

1. Is the applicant able to fund its share of required project funds?selectYesNo
   If no, theapplicantmayapply for exceptional circumstance byattaching a
   separate page outlining its case.

Authorisation

Provide the name of a senior office-bearer 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.

Lodging applications

Electronic applications are preferred and can be lodged at . Alternatively, you can post your application to the Grants Program CoordinatorWaters, Wetlands and Coast Division, Office of Environment and HeritagePO Box 3720 PARRAMATTA NSW 2124. Please do not email and post your application.

Applications must be submitted by 5 pm,28 February 2012.

Checklist

Please ensure you:

read the Coastal and Estuary Management Programs Grant Application Guidelines 2012-13.

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 Q31 or 32.

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 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 28 February 2012.

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[*] LGA, CMA Region, State Electorate and Catchment information required for Program reporting purposes only.