Floodplain Management Program 2011–12
Form A: Application form for financial assistance –
continuing staged projects
Closing date: 5 p.m. Monday 21 February 2011
You will need the Floodplain Management Program 2011-12: grant application guidelines prepared
by the Department of Environment, Climate Change and Water NSW (DECCW) to help you fill out
this application form. The guidelines are available on
www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm.
To complete this form electronically, please type in the shaded areas shown as °°°°°; and click the
mouse in the appropriate shaded boxes .
1
Applicant details
Applicant’s name and ABN
Applicant:
Applicant’s ABN:
Contact details
Name:
Position:
Address:
Phone/mobile:
Fax:
Email:
2
Project details
Project name (as noted in previous funding agreement)
Form A – Application form for financial assistance – continuing staged projects Page 1 of 6
Grant number (as noted in previous funding agreement, e.g. 2010-11-FM-00XX)
3
Project category (click in the appropriate box or boxes)
Only one box should be ticked unless you meet the scenario outlined in the grant application
guidelines for this question.
Continuing staged floodplain risk management plan development incorporating:
Flood study
Floodplain risk management study and plan
Climate change impact assessment in existing studies, plans or designs
Continuing staged floodplain risk management plan implementation project
including:
Investigation/concept design including flood warning systems (considering
climate change where applicable)
Environmental assessment, design and tender documentation
Integrated scheme and structural works project
Project to instigate improvements to evacuation management
Project to instigate improvements to flood warning systems
Voluntary purchase or voluntary house raising projects
4
Project activity (e.g. study, plan, levee construction)
5
Project timeframe
Date project commenced:
Proposed completion date:
Page 2 of 6 Floodplain Management Program 2011–12
6
Project location
Enter location description. Where possible, include town, latitude, longitude, nearby road,
beach or other notable landmark. Attach a locality diagram if you wish:
If the project location falls across more than one local government area (LGA), catchment
management authority (CMA) region, electorate or catchment, please identify primary one
first.
LGA1
7
CMA region
State electorate(s)
Catchment (if
applicable)
Budget overview
Note: funding is provided on a $2 from the grant fund:$1 from the applicant ratio (include all
funding sources)
Financial
year
Applicant’s
contribution
Other
contributions
Grant amount
sought
(if applicable)
(excluding GST)
Total funds
(excluding GST
#
8
2011–12
$
$
$
$
2012–13#
$
$
$
$
Remaining# $
$
$
$
Anticipated funds required for DECCW forward planning purposes only
Are exceptional circumstances sought for reduced council
contribution (click in appropriate box)?
Yes
9
No
Financial commitment to the project
Has a budget been allocated in 2011–12 for this project?
Yes
No
Do you have documentation that shows financial
commitment to the project?
Yes
No
If yes, what is this documentation?
1
LGA, CMA Region, State Electorate and Catchment information required for Program reporting purposes
only.
Form A – Application form for financial assistance – continuing staged projects Page 3 of 6
10 Project summary
Provide a brief project overview, including location and issue the project will address. This
will be used for promotional purposes – max 150 words:
11 Other funding sources
Have you applied or do you intend to apply to other organisations for funding for this project
or components of this project (click in appropriate box)?
Yes
No
If ‘Yes’, please provide details below:
12 Updated work plan
You must attach an updated work plan in Microsoft Excel format, which outlines progress
to date as well as the forward work plan for the project. The template for the plan is available
at www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm.
13 Capacity to deliver
Outline your capacity to deliver the project, having regard to your past grants
management history, available resources and the proposed timeframe and whether it is
realistic based on completion of prerequisite consultant briefs, preconstruction work or
approvals)
14 Funding agreement
Do you agree to enter into, and be bound by, the conditions in a funding agreement, as
outlined in the grant application guidelines (click appropriate box)?
Yes
No
Page 4 of 6 Floodplain Management Program 2011–12
Authorisation
Provide the name of a senior office-bearer in your organisation, with appropriate delegation, who
has authorised the submission of this project and has the delegation to authorise the commitment
of the resources and expenditure required to deliver this project.
Name:
Position:
Phone no:
Email:
Date:
Lodging applications
Email your completed application form to coastalestuary.floodgrants@environment.nsw.gov.au.
Alternatively, post the form to the Grants Program Coordinator, Waters, Wetlands and Coast
Division, Department of Environment, Climate Change and Water PO Box 3720 PARRAMATTA
NSW 2124. Please do not email and post your application.
Applications must be submitted by 5 p.m. Monday 21 February 2011.
Form A – Application form for financial assistance – continuing staged projects Page 5 of 6
Checklist
Please ensure you:
read the Floodplain Management Program 2011-12: grant application guidelines (see
www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm)
check this is a continuing staged project, as defined in the Floodplain Management
Program 2011-12: grant application guidelines
submit one application form for each project
only include one application form in each Microsoft Word document
answer all the questions in the application form
type only in the spaces provided in the application form
manually spell check your application (the Microsoft Word spelling and grammar function is
disabled in the form function)
enter monetary amounts in full e.g. $10,000 not $10k
enter the State, not Federal, electorate(s) at question 6
check the budget amounts outlined in your attached updated work plan are consistent with
the budget overview in question 7
attach your updated work plan (required at question 12) in Microsoft Excel format
have your application authorised by the appropriately delegated person
save your application form as a Microsoft Word document
include your organisation name then project name in the subject line of your email when
lodging the application (e.g. XX Council – XX Flood Risk Management Study and Plan).
submit your application by the closing date – 5 p.m. Monday 21 February 2011.
DECCW 2010/1014
Page 6 of 6 Floodplain Management Program 2011–12