Name of Group Click here to enter text.
Postal address
Town / City
Primary Contact Officer
Contact title
Phone
Email
ABN
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Postcode
Surname
Mobile
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PROJECT DETAILS
Project title
(20 words max)
Location of where on- ground works will be undertaken
Attach a Map
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Provide a map of project site including location of specific works
Preferably GIS layer
Lot and DP details
Lot DP
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Central Tablelands Local Land Services
Tel: 63637872 | centraltablelands.lls.nsw.gov.au
Internal use only
IRIS Ref. No:
Date received:

Project description
Project summary (250 words max)
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Have you discussed this project with local LLS staff,
Landcare Buddy or Regional Landcare Facilitator?
Yes
☐
No
☐
What is the sustainable land use practice change that your project is addressing and how does it link to the priorities
and goals of this program? (200 words max)
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What further evidence is there to support the value of this project? (100 words max)
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How will this project effect surrounding land users- ie upstream/downstream waterway users, surrounding
landholders, etc? (150 words max)
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List any project partners/collaborators
What is their role in the project?
List Community engagement initiatives associated with this project
Proposed project outcomes
Outcome Number
Total area project will
impact
Description
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Central Tablelands Local Land Services
Tel: 63637872 | centraltablelands.lls.nsw.gov.au

Community groups engaged
Participants involved at community events
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Media outputs
Educational and
Interpretive material to be produced
Training events
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List On-ground Outputs
(eg.number of plants, weeds controlled, length of riparian rehabilitation etc – add extra rows as nec.)
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Other Click here to enter text.
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Timetable of Works -
Include all major outputs – community planting days, media releases etc
NOTE ALL WORKS AND FINAL REPORT ARE TO BE COMPLETED NO LATER THAN MAY 2016
15/August Sept Oct Nov Dec 16/Jan Feb March April May
Budget - Add extra rows as necessary
Item Cost
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Central Tablelands Local Land Services
Tel: 63637872 | centraltablelands.lls.nsw.gov.au
Grant
(up to $40,000
Council cash contribution
In-kind contribution

+ GST)
How will this project be monitored and maintained? (150 words max)
(At a minimum monitoring is to include photo points – before and after)
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Please include any additional information/attachments –plans, species lists etc.
Conflict of Interest
Do you know of any Conflicts of Interest for funding eligibility?
☐ Yes ☐ No
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I declare the information entered on this form is true and accurate to the best of my knowledge.
Name of authorised officer:
Signature Date
______________________________________________________________________
INQUIRIES: Liz Davis | 6363 7872 | 0427 452 662
Please return your completed application to:
POST: Central Tablelands LLS
PO Box 20
Bathurst NSW 2795
EMAIL: ctlls.projects@lls.nsw.gov.au
All applications must be received by 28 August 2015
Any incomplete EOIs will be returned and will result in a new submission date.
Funding applications received after 28/8/2015 may be ineligible for funding.
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Central Tablelands Local Land Services
Tel: 63637872 | centraltablelands.lls.nsw.gov.au