Restoration & Rehabilitation Program – 2015/16
Application Form
Closing date: 5.00 pm, Friday 18 September 2015
About the program
The Restoration and Rehabilitation Program is a contestable grants program seeking to achieve long-term
beneficial outcomes for the NSW environment.
Funded by the NSW Environmental Trust, the program encourages and enables community and government
organisations to protect, conserve and restore our valuable natural environment.

For further information about the program, including eligibility requirements, please refer to the Restoration
and Rehabilitation Program Guidelines.

Use the How to complete your Application guidance when completing this form.

Answer every question. Where a question does not apply to your application, write ‘not applicable’ or
preferably, briefly explain why.

Grey boxes (
) represent sections which require your input. These boxes will expand as you type,
however, the amount you can enter is restricted to the size of text boxes provided - please ensure you
make good use of the available space.
Questions?
If you require assistance with completing the application form, please contact the Environmental Trust
on (02) 8837 6093 or info@environmentaltrust.nsw.gov.au
Applicant:
Project Title:
Funding Requested:
$
Project description:
(100 words or less)
2015/16 Restoration and Rehabilitation Program - Application Form
Page 1
See p.4 in “How to complete
your Application”
Section A: Registration
A1
Applicant organisation’s details
Name of organisation
What is your ABN?
Registered for GST
Yes
or No
Postal address
Suburb
A2
State
Primary contact for the Project (for all correspondence)
Title
First name
Surname
Position
Daytime phone
Mobile
A3
A4
Postcode
(0 )
Email
What is the legal status of your organisation? (Select only ONE box)
Community group
Local government
Not-for-profit organisation
Regional organisations of councils
Incorporated association
Other local-government controlled organisation
Private business/industry
State government
Company limited by guarantee
Other (please specify below):
Please provide details of your insurances.
It is a condition of your grant that you have adequate insurance cover including public liability
insurance of $10 million, workers compensation and volunteer insurance.
Company
Policy No.
Coverage
Currency (expiry date)
A5
Has your organisation previously received Environmental Trust funding?
Program
Reference
number
Project name
Yes
Amount
or No
Status
$
$
$
$
$
2015/16 Restoration and Rehabilitation Program - Application Form
Page 2
Has your organisation received grant funding for this project site from
a body other than the Trust?
A6
Funding source
Year
Project name
Yes
or No
Amount
Status
$
$
$
If you are a state or local government organisation, proceed to Question B1.
All other organisations must complete Question A7 and Questions A8 – A9 (if applicable).
A7
How does your organisation function?
How does your organisation make decisions?
(e.g. Board, Committee, Quorum of members, Director)
President/Chair/CEO
Office Bearers:
Treasurer/CFO
Number of years
operating
Registration no.
Number of employees
Full-time
Part-time
If you are a membership based organisation,
approximately how many members do you have?
Administrator details (if applicable)
A8
Administrator
Name of organisation
Administrator’s ABN?
Registered for GST
Yes
or No
Postal address
Suburb
A9
State
Postcode
Contact details for Administrator
Title
First name
Surname
Position
Mobile No.
Daytime phone
(0 )
Email
2015/16 Restoration and Rehabilitation Program - Application Form
Page 3
See pp.5-8 in “How to
complete your Application”
Section B: Your project (summary)
B1
Project title (maximum of 68 characters including spaces)
B2
Project category - what is the main focus of this project? Select only ONE box from the following choices
Vegetation management including bush
regeneration, weed management, fencing of
remnant vegetation, revegetation
Protection of habitat including wildlife corridors,
threatened species/endangered ecological
communities, control of non-indigenous species
Wetland management
Weed management
Water quality including riparian restoration,
weir removal, erosion, stormwater
Other – give details.
Is your project location a state heritage listed site?
Yes
No
Where will the project take place?
B3
Local government area
Local Land Services area
State electorate
Latitude
Longitude
Who owns and/or has legal responsibility for the site/s?
Do you have approval/permission to undertake works on the site/s?
Yes
or No
B3a Biodiversity Investment Opportunities Map (Western Sydney and Illawarra only)
Is your site identified as a Priority Investment Area on the OEH Biodiversity
Investment Opportunities map?
B4
Yes
or No
Budget and timeframe
Timeframe
(indicate start and completion dates for each stage)
Funding requested
Stage 1
to
$
Stage 2
to
$
Stage 3
to
$
Totals
2015/16 Restoration and Rehabilitation Program - Application Form
$
Page 4
Section B: your project (justification)
B5
Why is your project needed?
B6
What do you hope to achieve?
B7
What studies, reports, assessments or plans exist for the site and/or the issue?
Please explain how your project addresses them.
Study, report, assessment or plan
B8
Describe which particular component of the document your project
relates to and how it will attempt to address the issue and/or meet a
particular target.
If there are no reports, assessments, or plans, what is the scientific/technical/other basis for
your assessment of the environmental issue?
2015/16 Restoration and Rehabilitation Program - Application Form
Page 5
B9
Is this project part of a larger, on-going program?
B10
Please explain how this issue is not core business or the legal responsibility of any person or
organisation.
Does your project involve any Endangered Ecological Communities (EECs)?
B11
If so, list the EEC(s) below and advise what methods were used to verify their presence (e.g.
site plan of management, OEH mapping, OEH advice, etc). Also refer to question B12 below.
Yes
or No
Yes
or No
Does your project involve any threatened species?
B11a
B12
If so, list the species below, their SOS listed management stream and sites at which they
are present? Also refer to question B12 below.
What permits are necessary for you to undertake your project (owners, local, state and federal
authorities)? If your project is successful you will need to provide proof of your licences.
2015/16 Restoration and Rehabilitation Program - Application Form
Page 6
See pp.9-15 in “How to
complete your Application”
Section C: Project planning
C1 Project planning
OBJECTIVE 1:
What will success
look like if you
achieve this
objective?
Activity
(Significant steps or actions that are
needed to produce the identified objective)
How will you monitor progress?
(Record the number of people trained,
transects to assess vegetation present
etc.)
2015/16 Restoration and Rehabilitation Program - Application Form
Stage/s activity will be
undertaken
(Stage 1, 2 or 3 as indicated
at A4 or across multiple
years if applicable)
Page 7
OBJECTIVE 2:
What will success
look like if you
achieve this
objective?
Activity
(Significant steps or actions that are
needed to produce the identified objective)
How will you monitor progress?
(Record the number of people trained,
transects to assess vegetation present
etc.)
2015/16 Restoration and Rehabilitation Program - Application Form
Stage/s activity will be
undertaken
(Stage 1, 2 or 3 as indicated
at A4 or across multiple
years if applicable)
Page 8
OBJECTIVE 3:
What will success
look like if you
achieve this
objective?
Activity
(Significant steps or actions that are
needed to produce the identified objective)
How will you monitor progress?
(Record the number of people trained,
transects to assess vegetation present
etc.)
2015/16 Restoration and Rehabilitation Program - Application Form
Stage/s activity will be
undertaken
(Stage 1, 2 or 3 as indicated
at A4 or across multiple
years if applicable)
Page 9
C2
Complete the project measures that you hope to achieve over the life of the project.
Project measure
(Measures that enable you to determine if the activities/ objectives set out in your
project plan have been achieved e.g. number of participants, area weeded etc.)
C3
What are some of the potential risks that could hinder progress on the project and how will you
manage them?
Risk factor
C4
Total projected
(This is the projected result
of your project measure)
How risk will be managed
What will you do to maintain the project outcomes after funding finishes and what long-term
benefits or flow-on effects will result from your project?
2015/16 Restoration and Rehabilitation Program - Application Form
Page 10
C5
How will the site be maintained after the funding period?
Who will undertake this work?
Local Council will maintain
Yes
or No
Landholder will maintain
Yes
or No
Volunteer/local bushcare group
Yes
or No
Other – give details:
Yes
or No
Section D: Project delivery
D1
See pp.16-17 in “How to
complete your Application”
Who was involved in the planning and development of the project?
Who was involved?
D2
Has this been confirmed?
What was their involvement?
Who is involved in undertaking or managing the project?
Role in project
(job/function)
Who is undertaking that role?
(name/organisation)
2015/16 Restoration and Rehabilitation Program - Application Form
Previous experience
Funded
by?
Page 11
D3
D4
Previous experience
Briefly outline the previous experience held by your organisation in undertaking projects of a similar
nature to the one proposed in this application.
Relevance to local area
Explain how your organisation has links with the local area in which the project will take place.
Please explain if the Trust is being asked to fund an existing employee.
D5
D6
The Trust will not pay for existing staff whose salaries have already been funded from another source, but
recognises that there may be room for part-time or temporary staff to have their contracts adjusted and funded by
the Trust. Please outline the funding arrangements.
Please declare any real, potential or perceived conflict of interest that you may be aware of.
This can relate to land ownership, salary and/or contractor payments.
2015/16 Restoration and Rehabilitation Program - Application Form
Page 12
See p.17 in “How to
complete your Application”
Section E: Referees
Please provide details of two referees we can talk to about your organisation and your project.
Referee 1
Referee 2
Name
Name
Title/position
Title/position
Organisation
Organisation
E-mail
E-mail
Phone no
(0 )
Mobile no
Fax no
(0 )
Mobile no
(0 )
Section F: Authorisations
APPLICANT
Phone no
Fax no
(0 )
See p.17 in “How to
complete your Application”
Include the name of an office-bearer in your organisation (e.g. Chairperson, Chief Executive
Officer or Executive Officer) who is able to attest to the accuracy of the information within the
application, and can commit your organisation to undertake the project if funded. This person
will be a secondary contact for the project if required.
Name
Title/position
Organisation
E-mail
Phone no
(0 )
Date
*Note:
If the project is on land owned by the office-bearers, those office-bearers cannot authorise the
application
ADMINISTRATOR
(only necessary if the grant is being administered by another organisation).
Please provide the name of senior manager within the administering organisation who
can confirm that the organisation is prepared to act as administrator should the
application be successful.
Name
Title/position
Organisation
Email
Phone No.
(0 )
Date
2015/16 Restoration and Rehabilitation Program - Application Form
Page 13
See p.17 in “How to
complete your Application”
Section G: Applicant feedback
Please provide some basic feedback on your experience with applying to the Restoration and Rehabilitation
program. All feedback will be collated to provide overall picture and used to assist development of future
Environmental Trust documentation.
G1
G2
G3
Time taken to develop your project
<5 hours
5-20 hours
20-40 hours
>40 hours
Time taken to complete the application form
<2 hours
2-5 hours
5-10 hours
>10 hours
Difficulty completing the application
Very easy
Easy
Moderate
G4
Where did you hear about this program?
G5
Anything else you’d like to add regarding the process?
2015/16 Restoration and Rehabilitation Program - Application Form
Difficult
Very difficult
Page 14
See p2-3 in “How to
complete your Application”
Section H: 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, particularly those sections covering the objectives of the program,
eligibility and assessment criteria.
Grant application check list
Submit your entire application by ONE of the methods below. (i.e. DO NOT Email AND post). Email is the
preferred option.
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 Application Budget Form
Have your application authorised by the appropriately delegated person.
Attach any required supporting information: CVs (maximum 2 page summary), briefs and job descriptions,
letter(s) confirming other funding. 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. See p.19 “How to complete your application”
Attach an A4-size map (including a scale).
Submit your application by the closing date – 5.00 pm, Friday 18 September 2015
 Ensure you email your entire application, including
all attachments, e.g. maps; CVs.
Email to:
apply@environmentaltrust.nsw.gov.au
 NB: Emailed applications must not be larger than
10MB including all attachments.
 Please email the application form as a Word
document and the budget spreadsheet as an
Excel document - DO NOT PDF. Attachments can
be emailed as Word, Excel or PDF documents.
OR
Post to:
NSW Environmental Trust
PO Box 644
PARRAMATTA NSW 2124
 Only electronic applications will be accepted.
Any application that is late, incomplete or ineligible will not be considered.
Published by the NSW Environmental Trust, PO Box 644, Parramatta 2124 Phone: 02 8837 6093 Fax: 02 8837 6099
Email: info@environmentaltrust.nsw.gov.au Website: www.environment.nsw.gov.au 2015/0370 June 2015
2015/16 Restoration and Rehabilitation Program - Application Form
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