Local Government NSW

Flying–foxes GrantsProgramApplication Form

Stream 1 and 2 proposals apply from 16 June 2016 up until 30 April 2017

Stream 3 proposals closing date: Friday 26 August 2016

General information

a)An online application form will be made available by 30 June 2016, which will replace this form. The online form will mirror this document, therefore you can use this form as a guide for preparing your application in the intervening period.

b)If you wish to submit an application prior to 30 June 2016, please use this form and email it to . See Section H of the application form for more details.

c)You will need to read the Guidelines for Applicantsto help you fill out this application form.

d)Councils may apply for funding in more than one stream, however a separate application will need to be completed for each stream.

e)Please answer every question. Where a question does not apply to your application, write ‘not applicable’ or preferably briefly explain why.

Section A – REGISTRATION AND ADMINISTRATION
A1 / Applicant’s details
Name of council/organisation
What is your ABN?
Postal address
Suburb / State / Postcode
A2 / Contact person for this project
Title / First name / Surname
Position / Daytime phone / (0)
Mobile / Email
A3 / EligibilityCriteria
Note that a separate application will need to be completed for projects in different streams.
(a) / Are you a local government organisation? / Yes or No
(b) / Are you applying as a regional grouping (2 or more councils)? / Yes or No
(c) / If yes to A3(b),please list the councils involved in your project:
d
A4 / Project location - What is the location of the camp to which your proposal applies? Please provide latitude and longitude for the camp, and camp name where known.
Latitude / Longitude
Camp name:
A5 / Is this considered to be a nationally-important flying-fox camp?
Use the flying-fox viewer to check. / Yes or No
(a) / If yes, have you referred your proposed action(s) to the Australian Government (under the Environment Protection and Biodiversity Conservation Act 1999)? Please detail. / Yes or No
Section B - FUNDING STREAM
B1 / Please indicate the funding stream for which you are applying:
Tick one stream only. Note that a separate application will need to be completed for each stream.
Refer to the Guidelines for Applicantsfor more detail.
Stream 1: / Implementing emergency flying-fox camp management measures where there are significant community impacts.
Applications can be made from 16 June 2016 up until 30 April 2017 and will receive funding if they are for eligible activities and meet the assessment criteria (subject to funding availability).
Provide a link to your plan (or attach) :
Stream 2: / Preparing flying-fox camp management plans.
Applications can be made from 16 June 2016 up until 30 April 2017 and will receive funding if they are for eligible activities and meet the assessment criteria (subject to funding availability).
Stream 3: / Implementing approved actions in flying-fox camp management plans.
Round 1 closes 26 August 2016. Applications will be assessed on a contestable basis against other applications using the assessment criteria outlined in the Guidelines.

Please complete the questions for the relevant stream below.

Stream 1 - Implementing emergency flying-fox camp management measures where there are significant community impacts.

Have you demonstrated that:

The impact of flying-foxes on the camp are such that conditions represent a threat to life or property? Provide details. / Yes or No
d

And/ or

There is an unprecedented incursion of flying-foxes? Provide details / Yes or No
d

And

The flying-fox camp is within 300 metres of human settlements including residences, businesses schools and hospitals? Provide details. / Yes or No
d
Stream 2: Preparing flying-fox camp management plans.

Have you demonstrated that:

A camp management plan has not already been completed for the flying-fox camp, or the existing plan needs to be updated? Provide details. / Yes or No
d

And

Council has committed to seek adoption of the plan upon completion? / Yes or No
d

And

The flying-fox camp is on council-managed land, or the council has agreed to be the funding proponent for a camp on other land?Provide details. / Yes or No
d
Stream 3: Implementing approved actions in flying-fox camp management plans.

Have you demonstrated that:

The proposed actions are part of an existing camp management plan? Provide a web link to the relevant plan or attacha copy of your draft plan. / Yes or No
d

And

Proposed actions, where necessary, have been approved by Office of Environment and Heritage under the relevant legislation? Provide details, including details of the approval and the OEH office to which you have submitted your application. / Yes or No
d
Section C - PROJECT DETAILS– for all streams

Note: The Proposed Work Plan form should be filled out with details of the project milestones, activities, measures, and funding requirements. Elements of the Proposed Work Plan will be required to complete this application form.

C1 / Project title (maximum of 68 characters including spaces)
C2 / Time frames - your project timeline and reporting deadlines
Proposed start date
Proposed completion date /
  • Projects must be completed by 30 June 2017.

Submit final report /
  • Final reports are due by 30 September 2017.

C3 / List your project objectives (maximum of 5)
These are what you want to achieve with your project, not a list of activities.
d
C4 / What actions are you proposing and why are they required?
(Max 150 words including project description and need).
d
C5 / For applications under Streams 1 and 3, how will your proposed project address theimpact of flying-foxes on local communities? How will you meet this objective while minimising harm to flying-foxes?
d
C6 / What are the project outcomes?
(When answering this question, imagine what the success of your project will look like).
d
C7 / List any project partnersand specify their role in this project.
Attach letters of support to this application.
Partner / Role
d / d
d / d
d / d
C8 / Please identify the potential risks that could hinder progress of the project, and how you will manage them.
Risks / How will you manage them
d / d
d / d
d / d
C9 / Please declare any actual, potential or perceived conflicts of interest that you are aware of. This could relate to land ownership, salary and/or contractor payments.
d
C10 / For projects in Streams 1 and 3, councils will be expected to maintain the worksafter the funding period. Describe this maintenance commitment.
d
Section D - PROJECT BUDGET

This part of the application form is a separate Excel document and can be downloaded from LGNSW’swebsite. See ‘Proposed Work Plan’ – Excel application form.Please complete the Excel document and submit with your application.

Note that applicants will be required to commit matching funds or in-kind contributions for any proposal on a 1:1 basis. Proposals with higher matching cash contributions may be more competitive in the assessment process.

D1 / Have you completed and attached the ‘Proposed Work Plan’? / Yes or No
D2 / Total project budget – provide details of council and partner contributions, both cash and in-kind. These details should be reflected in your Proposed Work Plan form.
Total project budget / $ / This is the total amount for the project (cash and in-kind).
Cash / $ / Total cash contributions from all parties, including the grant amount sought.
In-kind / $ / Total in-kind contributions from all parties.
D3 / Grant amount you are seeking (from Proposed Work Plan form)
Total amount requested / $ / Note: grants under Streams 1 and 3 cannot exceed $50,000 for individual councils, and grants under Stream 2 cannot exceed $15,000 for individual councils. Total grants cannot exceed $150,000 for two or more councils.
A more detailed budget is to be provided in the Proposed Work Plan form.
D4 / It is a condition of your grant that you have adequate insurance cover including public liability insurance of $20 million, workers compensation and volunteer insurance. Please provide details of your insurance(s) below.
Company
Policy No/s
Coverage
Currency (expiry date)
Section E – AUTHORISATIONS
E1 / Has this application been approved by Council’s General Manager / your organisation’s CEO? / Yes or No
Name
Position
Signed
Date
Section F – ENQUIRIES
Contact: / Susy Cenedese
Strategy Manager
Local Government NSW
Phone: / 02) 9242 4080
Email: /
Section G – SUBMISSION DETAILS

Use the following checklist to make sure that your application is complete and accurately represents your project. You should read the Guidelines for Applicants to ensure your application is eligible.

Note that an on-line application form will be available by 30 June 2016. This form (Word document) is provided as an interim measure. The on-line form will mirror this document, so you may use this to guide preparation of your proposal.

Grant application check list
Answer all the questions in the application.
Type only in the spaces provided in the application form. The boxes provided for answers to questions are a set size; the boxes will not expand to accommodate additional text if you continue to type beyond the bottom of the text box. Please ensure answers to questions are fully contained within the limits of the text boxes.
Complete and attach the Proposed Work Plan (excel spreadsheet)
Have your application authorised by the appropriately delegated person (e.g. General Manager, Chief Executive).
Additional information should be kept to a minimum. If your application refers to a large document, only include the relevant pages of that document i.e. title page, executive summary, relevant page/s, or provide a weblink. Attach relevant job briefs and letters confirming other funding sources.
For Stream 1 and 2 applications, you may submit your application from 16 June 2016up until30 April 2017.
For Stream 3 applications, submit your application by the closing date– Friday 26 August 2016.
For applications submitted prior to 30 June 2016:
If you are submitting an application prior to the on-line form becoming available (i.e. before 30 June 2016), please email your application to
  • Ensure you email your entire application, including all attachments. Your application will consist of:
  • Part 1: Application Form (word document)
  • Part 2: Proposed Work Plan (excel document)
  • Additional attachments as determined
  • NB: Emailed applications must not be larger than 10MB including all attachments.
  • Please email the application formas a Word document, the Proposed Work Plan as an Excel Document (DO NOT PDF). Attachments can be emailed as Word, Excel or PDF documents.

Any application that is late, incomplete or not eligible will not be considered.

Published by: LGNSW, GPO Box 7003, SYDNEY NSW 2001 Phone: 02 9242 4000

Email: Website: June 2016

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Flying-foxes Grant Program– Application Form1