Wimmera Regional Community Grants
Round Two Application Form
Does your group have overdue project activities or final reporting with Wimmera CMA?
Yes
No
Email submissions to: [email protected]
Post submissions to: PO Box 479 Horsham VIC 3402
Contact: Joel Boyd, Community Delivery Manager (03) 5382 9919
Applications close: 5 October, 2015
1. Group details
Group Name:
Key contact person for the project:
Postal Address:
Phone Number:
Email:
Estimated total land area (ha) currently covered by your group:
ha
Number of group members:
How many new members joined your group in the last year?
Number of non-members who volunteered for your group in the last year:
Estimated total volunteer time (people hours) contributed through your group in an average month:
Estimated percentage of your group’s time spent on the following types of activities:
On-ground works
%
Learning/training
%
Admin & planning
%
Promotions & comms
%
Which best describes your group?
More active than 5 years ago
Less active than 5 years ago
About as active as 5 years ago
Which best describes the overall health of your group?
Trail blazers
Thriving
Rolling Along
Stable
Struggling a little
Just surviving
Stalling/stalled
1
2. Insurance
Is your group covered for public liability and personal accident insurance?
Yes
No
To qualify for Wimmera Regional Community Grants project funding groups must be insured for
public liability insurance of $10M and personal accident insurance, or operate under the
auspices of an organisation that carries such insurance.
3. Incorporation and GST
Is your group incorporated?
Yes
No
Is your group or the auspicing organisation registered for GST?
Yes
No
ABN:
4. Banking details
If your application is successful the funds will be released by EFT.
Bank Name:
Account Name:
BSB Number:
Account Number:
5. Group declaration
On behalf of the group we understand that this is an application only and that final approval will be subject to funding
availability and assessment of the proposal. Funding is not available for work completed prior to project approval and the
signing of an agreement.
Successful groups will be required to enter into a signed agreement with Wimmera CMA that provides a summary of agreed
works, timeframes and reporting requirements. This agreement will be a legal document. By signing this agreement your group
will be agreeing to abide by the terms and conditions of the agreement.
We declare that the group has been consulted about the details of this application and have agreed to apply for the above
specified grant. We confirm that the information provided is correct and complete and certify that the necessary approvals
required by our group have been granted for the project to proceed.
Office bearer’s signature:
Name:
Position:
Date:
Project Manager Signature:
Name:
Date:
Privacy
Personal information supplied by you is collected, stored and maintained for the purpose of administering 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 for 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 CMA staff.
2
6. Project information
Project title
Project site/s:
Please include mapping. Large planning maps are available for all group areas from Wimmera CMA if
required.
Brief description of project
Groups receiving a Project Grant will be required to lodge a Final Report by June 15, 2016.
Mapping of all project works will be an important part of your reporting. The reporting templates will be
provided if your application is successful.
3
7. Links with local and regional strategies
Type of
strategy/plan
How does this project link to the strategy/plan?
Wimmera Regional
Catchment
Strategy
Other plans (eg.
Wimmera Invasive
Plant and Animal
Management
Strategy 2010-15)
-
8. Choose the National Landcare Programme objective/s the project will target
Objective
Communities are managing landscapes to sustain long-term economic and social benefits
from their environment.
Farmers and fishers are increasing their long term returns through better management of
the natural resource base.
Communities are involved in caring for their environment.
Communities are protecting species and natural assets.
4
9. Project budget and outputs
Activity
Expected output
How many
- ha weed/rabbit control?
- ha reveg?
- km fencing?
- events held?
- participants involved?
- other achievements
expected?
Applicant contributions
from your group
CASH
IN KIND
Wimmera
Regional
Community
Grant Funding
Request
Total Activity
Cost
TOTAL
GST: Do not include GST in project budget figures in your application. If your group or organisation is registered to collect GST, this will be added to the allocated funds.
5
10. Risk assessment
What are the major foreseeable risks facing your project, and what measures will you have in place to reduce their impact?
Risk
Mitigation measure
6
11. Consultation, permits, and compliance with legislation for on-ground works
Your group is responsible for seeking and obtaining the required works approvals from all relevant land managers
and agencies.
a. Land Manager
Will the proposed works be on public land?
Yes (seek relevant land manager approval)
No
Will the proposed works be on private land?
Yes (seek relevant land manager approval)
No
Details of contact with land manager/s:
b. Indigenous Cultural Heritage
Does your project involve disturbance of earth deeper than 600mm?
Yes
No (go to c)
Your group is responsible for ensuring your project complies with legislation regarding the protection of all known
and unknown indigenous cultural heritage sites.
Assessment: Have you already consulted with a Registered Aboriginal Party/the Office of Aboriginal Affairs or had
an onsite assessment for sites of Indigenous cultural heritage significance at or near your project area?
Yes
No
Protection: If there are registered sites of indigenous cultural heritage significance at or near your project site, you
must ensure they are protected.
c. Native vegetation
Sometimes Landcare projects include works that may result in the removal, destruction or lopping of native vegetation (such as
warren ripping).
Does your project impact on native vegetation?
Yes (your group is responsible for obtaining permits and agency approvals)
No (go to d)
d. Occupational health and safety (OHS)
Your group is responsible for ensuring you have a safe system of work in place to protect the health and safety of
your group members, other volunteers and anyone else involved on the project site.
You can find resources on OH&S tailored to community groups on the Victorian Landcare Gateway:
http://www.landcarevic.net.au/resources/for-groups/ohs
7