Stock Containment Area Grants Program 2015/2016 Expression of Interest The Department of Economic Development, Jobs, Transport and Resources, and the Mallee Catchment Management Authority (CMA), North Central CMA, Wimmera CMA and Goulburn Broken CMA invites landholders to express their interest in undertaking works to protect their soils by installing a Stock Containment Area (SCA). A grant of $2000 will be allocated to successful applicants. Funding is not guaranteed. This application is an Expression of Interest only. Project funding will be subject to assessment against funding priorities and funding availability at the time of the application. All applicants will be advised of their applications success or otherwise. Please fill in all details on both sides and submit to your relevant CMA (details on reverse). EXPRESSIONS OF INTEREST CLOSE ON TUESDAY 15 DECEMBER 2015 Do you have a PIC number? Yes No If No, you are not eligible for a SCA grant. PIC Number:____________________________ Do you currently have livestock on your property? Yes No If No, you are not eligible for a SCA grant Usual stock numbers: Ewes_________Lambs________Wethers______ Cows_________Calves________Other (specify):_________ Current stock numbers: Ewes________Lambs________Wethers______ Cows________Calves________Other (specify):_________ Have you received a SCA grant in the past? Yes No If yes, what year?__________ Do you own the property? Yes No If No, you are not eligible for a SCA grant Do you have an ABN? Yes No ABN:_________________________________________ Name:________________________________________________________________ Telephone: (___)_________________ Fax: (___)__________________ Mobile _____________________________ Postal Address_____________________________________________________ Town___________________________________ Postcode_____________________ Page 1 of 2 Residential Address (Same as postal address ) Address________________________________________________________________ Town_____________________________________Postcode________________________ Email address________________________________________________________________ Map of property and proposed location of SCA (Please attach a map (eg CFA, Vic Roads, Google etc) of your property, noting the closest roads and marking the approximate area for the proposed SCA. If you need assistance with a map for your property please contact your relevant CMA (contact details below). Process Timeline: A case manager will be assigned to your application and will contact you to carry out their inspection during December 2015 or January 2016. Applications will be prioritised against funding availability and criteria outlined in the SCA guidelines. You will be notified of the result of your application as soon as possible. CONTACTS North Central CMA 628-634 Midland Hwy, Huntly 3551 Phone 03 5448 7124 Mallee CMA DPI Complex, Cnr Koorlong Ave and Eleventh St, Irymple VIC 3498 Phone 03 5051 4377 Goulburn Broken CMA 168 Welsford St, Shepparton 3630 Phone 03 5822 7700 Wimmera CMA 24 Darlot St, Horsham 3400 Phone 03 5382 1544 Privacy Statement: The Department of Economic Development, Jobs, Transport and Resources (DEDJTR) is committed to protecting information provided by you in accordance with the principles of the Information Privacy Act 2000. Personal information supplied by you is collected, stored and maintained for the purpose of administering the above-mentioned grant. This information may be disclosed to relevant government organisations or other agencies for the sole purpose of administering the incentive for which the information was collected. Your personal information will not be disclosed to any other organisation outside the delivery of this incentive, unless authorised by law or required for emergency response activities. Any reports or publications resulting from this project will ensure that information is anonymous. You have the right of access to this information by contacting your case manager. Department of Economic Development, Jobs, Transport and Resources privacy policy can be obtained from their website at www.agriculture.vic.gov.au/privacy Page 2 of 2