2015-2016 EG Community Grant Application Form
East Gippsland Community Grants
2015-2016
APPLICATION FORM
Applications are to be submitted to
Amanda Bartkowski
(Regional Landcare Coordinator)
No later than COB Friday September 11th, 2015.
By mail:
East Gippsland Catchment Management Authority,
PO Box 1012
Bairnsdale
VIC 3875 or
By email:
abartkowski@egcma.com.au
PLEASE NOTE: Funding is not guaranteed at this stage. Applications submitted will be assessed against criteria
outlined in 2015 - 2016 EG Community Grants guidelines provided with this application form, and ranked
accordingly.
Part 1. Applicant Details
Applicant Name:
ABN (if applicable):
GST Registered? Yes/No (circle)
Part 2. Project Manager Details
Individual with primary responsibility of managing this project on behalf of group/network.
Project Manager:
Postal Address:
Phone:
Mobile:
Email address:
Part 3. Eligibility Criteria Check List (section 2.2 of Guidelines)
Applicant Eligibility Criteria (please tick where criteria applies)
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A ‘not-for-profit’ community based group
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Incorporated or operate under the auspices of an incorporated organisation
Current public liability ($10M) and personal accident insurance (or operate under the auspices of an
organisation that carries such insurance)
Able to provide a copy of certificate of currency for insurances, if requested
Submitted all project reports for previous grants/funding to the EGCMA (if funded before)
General Project Eligibility Criteria (please tick where criteria applies)
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Clear public benefit is demonstrable
Project management no more than 15% for each project
Grants not used to employ support professionals
Part 4. Grant Type
Please tick, and if applying for both grant types, complete a separate application for each. For applicants
with more than one application, please remember to rank applications (section Part 5a)
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National Landcare Programme (NLP) Community Grant – go to Part 5
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Recreational fishers Grant - go to Part 6
Part 5a. NLP Community Grants Check List (section 2.2.2 of Guidelines)
NLP Project Eligibility Criteria (please tick where criteria applies)
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Belong Landcare, ‘Friends of’ and other community environment groups, farmer/producer groups,
Indigenous communities and organisations, and individual land managers working in the
Landcare/NRM sector
Works complement local and regional environmental priorities as outlined in the EG RCS (Part 3 of
guidelines
Weed control on private land ONLY for revegetation preparation or native vegetation management
Part 5b. NLP Community Grants Project Details
NLP Project Name
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Project Priority (if applicable): For groups with more than one application, please submit separate applications for
each, and rank in order of priority below, i.e. highest priority project ranked 1, next preference ranked 2, and so on.
This application is
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Ranked 1
Ranked 2
Ranked 3
Aims/Objectives: A summary of your project and a description of what your group expects to achieve on
completion, including RCS alignment and on-ground deliverables, e.g. 5 ha of revegetation, 0.5 km fencing
Project Design: Briefly describe the project plan including activities and timing. Dot points are sufficient.
Land Ownership and Consent for Project Activities
If the project involves works on private land, has landowner Yes / Not yet (please circle)
consent been obtained?
If the project involves works on public land, please provide the
responsible Agency's name
Has the responsible Agency's consent been sought?
Yes / Not yet (please circle)
If Yes, please provide the Agency contact name
Location of project: please include a map, aerial photograph or GPS coordinates.
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Part 5c. NLP Community Grant Project Budget
This table must be filled to qualify for project grant funding.
Item
Quantity/Type
Funding requested
In-kind
cash In-kind
labour
contribution
contribution
EXAMPLE
Stock
fencing
(protection
of
revegetation)
2 kms of 5 wire
fencing
2 kms @ $3.50/m =
$7,000
Vehicle 30 hrs
$50/hr = $1,500
Tractor 30 hrs
$70/hr = $2,100
x
x
150 hrs x $30/hr =
$4,500
TOTALS
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Do not include GST in project budgets. All costs should be exclusive of GST.
Go to Part 7 - Declaration
Part 6a. Recreational fishers Grants Check List (section 2.2.2 of Guidelines)
Project Eligibility Criteria (please tick where criteria applies)
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All works are conducted on public land adjacent to the Mitchell, Nicholson Tambo rivers estuaries
or the northern shoreline of the Gippsland Lakes
Works complement local and regional environmental priorities as outlined in the EG RCS (Part 3 of
guidelines)
Works must benefit fish habitat and/or river rehabilitation
Projects for works estimated to cost between $10,000 and $30,000 and benefit fish habitat and
river rehabilitation
Belong to Angling Clubs, Landcare, ‘Friends of’ and other community groups
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Part 6b. Recreational fishers Grants Project Details
Project Name
Project Priority (if applicable): For groups with more than one application, please submit separate applications for
each, and rank in order of priority below, i.e. highest priority project ranked 1, next preference ranked 2, and so on.
This application is



Ranked 1
Ranked 2
Ranked 3
Aims/Objectives: A summary of your project and a description of what your group expects to achieve on
completion, including alignment to EG RCS and EG Waterway Strategy, and on-ground deliverable, e.g. 0.5
ha revegetation, 1.0 ha weed control.
Project Design: Briefly describe the project plan including activities and timing. Dot points are sufficient.
Public Land Agency and Consent for Project Activities
Has the responsible Agency's consent been sought?
Yes / Not yet (please circle)
If Yes, please provide the Agency contact name
Location of project: please include a map, aerial photograph or GPS coordinates.
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Part 6c. Victorian recreational fishers Community Grant Project Budget
This table must be filled to qualify for project grant funding.
Item
Quantity/Type
Funding requested
In-kind
cash In-kind
labour
contribution
contribution
EXAMPLE
Revegetation
500
tube
stock
seedlings
planted,
indigenous
$750 - 500 seedlings
at $1.50 each
Vehicle for watering
in seedlings (10 hrs x
$50/hr = $500
150 hrs x $30/hr =
$4,500
TOTALS
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Do not include GST in project budgets. All costs should be exclusive of GST.
Part 7. Group or Network Declaration
On behalf of the individual/organisation who is the applicant for this project proposal, I/we declare:
1. The applicant individual/organisation and the project meet the eligibility criteria set out in the
2015-2016 East Gippsland Community Grant Guidelines;
2. All appropriate internal organisational approvals are in place for submission of this application;
3. The organisation supports this application and will, if successful, enter into a funding
agreement with the East Gippsland Catchment Management Authority to deliver the project
and administer the project’s funding.
Project Manager signature:
Name:
Date:
If applicable, organisation Office Bearer authorised to sign on behalf of the organisation (Must be an
individual other than Project manager).
Signature
Name:
Position:
Date:
Part 8. Privacy
Personal information supplied by you and/or contained herein is collected, stored and maintained for the
purpose of facilitating and administrating this grant process. This information may be disclosed to relevant
government organisations or other agencies for the sole purpose of administering the grant for which the
information was collected. The information collected is not traded, sold, licensed nor used to commercial
marketing purposes. You have the right to access this information. Sites are to be made available for
auditing, monitoring or demonstration purposes at the request of EGCMA staff.
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