Floodplain Management Program 2011–12
Form B: Application form for financial assistance – new
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 (maximum 70 characters)
Form B – Application form for financial assistance – new projects
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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
Floodplain risk management plan development incorporating:
Flood study
Floodplain risk management study and plan
Climate change impact assessment in existing studies, plans or designs
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
Proposed commencement date:
Proposed completion date:
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.
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If the project location falls across more than one local government area (LGA), catchment
management authority (CMA) region, electorate or catchment, please identify the 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
contributio
n
Other
contributions
Grant amount
sought
(if applicable)
(excluding GST)
Total funds
(excluding GST
#
2011–12
$
$
$
$
2012–13#
$
$
$
$
Remaining#
$
$
$
$
Anticipated funds required for DECCW forward planning purposes only
8 Are exceptional circumstances sought for reduced council
contribution (click in appropriate box)?
Yes
No
9 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 B – Application form for financial assistance – new projects
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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 grants at this location
Have you received any previous funding for projects at this location (click in appropriate
box?)
Yes
No
If Yes, please provide details below:
Project name
Funding source
(e.g. State Govt,
Commonwealth
Govt)
Program
name
Year
of
offer
Amount
Completion/expected
completion date
$
$
12
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:
13 Flood history and studies
Provide a brief description of the flood history of the project area and any information about
the severity of previous floods, and the damages and losses incurred (e.g. evacuation
required, essential services at risk of failure).
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14 Regional or state significance
Is this project of regional or state significance?
Yes
No
If Yes, please state why, including if there is an immediate threat.
15 Why is funding required (why would this project not proceed
without funding)?
16 Project objective (what you plan to achieve)
17 Project outcomes (the result, impact or benefits of the project, i.e.
its success).
Note: if your application is successful you will need to report against these outcomes in your
final report.
Form B – Application form for financial assistance – new projects
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18 Project outputs
Outputs are project activities which are tangible and quantifiable.
Note: if your application is successful, you will need to report against these outputs in your
milestone and final reports.
19 Preliminary work plan
You must attach a preliminary work plan in Microsoft Excel format. The template for the
plan is available at www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm.
20 Program’s objectives and priorities
How does the project meet the Floodplain Management Program’s objectives and priorities?
21 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)
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22 Funding agreement
Does the applicant agree to enter into, and be bound by, the conditions
in a funding agreement as outlined in the grant application guidelines (click in appropriate
box)?
Yes
No
23 Discussions with DECCW
Have you discussed the project details with a relevant DECCW officer (click in appropriate
box)?
Yes
No
Has technical advice been provided by a relevant DECCW officer?
Yes
No
If ‘yes’, provide the name of DECCW officer, and the nature of advice provided:
24 Floodplain risk management plan
Is the project listed in the relevant floodplain risk management plan (click in appropriate
box)?
Yes
No
Has the floodplain risk management plan been formally adopted by the council?
Yes
No
25 Community support
To what level is the project supported by the community?
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:
Form B – Application form for financial assistance – new projects
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Lodging applications
Email your completed application form to coastalestuary.floodgrants@environment.nsw.gov.au.
Alternatively, post the form to the Grants 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.
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Checklist
Please ensure you:
read the Floodplain Management Program 2011-12: grant application guidelines (see
www.environment.nsw.gov.au/coasts/InfoCoastEstFloodGrants.htm)
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 at question 7
attach your preliminary work plan (required at question 19) in Microsoft Excel format
have your application authorised by the appropriately delegated person
attach Form C if your project is for a new works project that has not already been ranked
under the Floodplain Management Authorities’ endorsed scoring system
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.
DECCW2010/1015
Form B – Application form for financial assistance – new projects
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