Lake Macquarie City Council Environmental Sustainability Grants 2018-2019 Round One Application form Closing date: Monday 20 August 2018, 5pm Applicants must submit their application to Council by 5pm on Monday 20 August 2018. Completed, signed applications should be marked to the attention of Karen Keogh, Sustainability Engagement Officer, and may be either: 1. delivered in person to Council s Administration Building, 126-138 Main Rd, Speers Point; 2. posted to LMCC, Box 1906, Hunter Regional Mail Centre, NSW 2310; or 3. emailed to kkeogh@lakemac.nsw.gov.au This Application form is an interactive pdf. If completing the form electronically, please make sure you use Adobe Standard and Adobe Professional software. You can download Adobe reader for free at https://get.adobe.com/reader/ Alternatively, you can print the form and fill it out by hand. Checklist for applicants I have read the Guidelines for Applicants document I have completed any outstanding grant final reports due to Council or have applied for an extension for previous grants, before applying for a new grant I have written permission from the landowner (if applicable) I have consulted with Council staff on the project proposal I have completed all sections of the application form The appropriate office bearers have signed the form I have kept a copy of my application Additional pages may be attached to the application as required Further information Karen Keogh Sustainability Engagement Officer Lake Macquarie City Council Phone: 4921 0333 Email: kkeogh@lakemac.nsw.gov.au Website: lakemac.com.au
1. Applicant details Name of applicant organisation(s): Contact person for the organisation: Postal address: Phone: Mobile: Email: ABN: Registered for GST? Yes No Applicants should indicate if they are registered for GST purposes. If so, an additional 10 per cent will be paid to cover the GST component. Is your organisation incorporated? Yes No If no, complete Section 2 as it is a requirement that the applicant organisation. If not incorporated, be sponsored by an incorporated body. Incorporation number: Have you received an environmental grant from Council in the past? Yes No 2.Sponsor organisation details (if applicable) Name of sponsoring organisation: Contact person for sponsoring organisation: Name: Position: Postal address: Email: Phone: ABN: Registered for GST? Yes No Incorporation number: Environmental Sustainability Grant Application Form 2018-19 Round One Page 2
3. Project contact person details Person primarily responsible for implementing delivery of the project. Council may contact this person from time to time for updates on the project. Name of project contact person: Phone: Mobile: Email: 4. Funds (should reflect those provided in the Budget - Section 18) Requested: Your organisation s total matching (actual and in-kind) funds: 5. Timeframe (please note funds will not be available until December 2018) Project start date: Finish date: NB: Projects must be completed and funds acquitted by December 2019. 6. Project name and location Project title: Project location: Please attach a map and/or site plan to assist the assessment panel understand your project if appropriate 7. Land ownership Name of landowner where project will be installed: Address where project will be installed: Have you received permission from the landowner to go ahead with the project? Yes No Please attach written evidence of the landowner s permission. For example, signed letter on school letterhead from Principal Environmental Sustainability Grant Application Form 2018-19 Round One Page 3
8. Project description and objectives Please clearly describe your project and its objectives (what you hope to achieve). Dot points are encouraged. Project description Objectives Environmental Sustainability Grant Application Form 2018-19 Round One Page 4
9. Background to the proposal Please explain your reasons for developing this project (For example, identified in school environmental plan, Sustainable Neighbourhood Action Plan, or integration with other programs). 10. What are the key environmental sustainability outcomes this project will deliver? Please list how the environment benefits from this project? (For example, on-ground ecosystem enhancement, water and energy efficiency, waste reduction, active transport, community resilience from natural disaster, increase in environmental resources such as signage/publications). Environmental Sustainability Grant Application Form 2018-19 Round One Page 5
11. What are the key social outcomes this project will deliver? Please list how the participants, community and/or target audience will benefit from the project? (For example, increased awareness, stronger community networks, improved access to resources and information, behaviour change) Who will be involved? How will the wider community be involved? 12. Lifecycle impacts Please list how you plan to minimise the environmental impacts of your project? (For example, when organising the working bee request people to bring own reusable drink bottle, mug and plate. Compost food waste or put it in the green waste bin from the event. Return tubestock containers to the nursery for re-use) 13. Education and training resources If you intend to produce written material of some kind, please list details of its format and content. (For example education or information resources including brochures, newsletter content, social media content, signage, or online material.) Environmental Sustainability Grant Application Form 2018-19 Round One Page 6
14. Promotion Please explain in detail who your target audience is and how you propose to promote your project to them. (For example, promotion through newsletters, online, social media, launch events or media releases). 15. How will you acknowledge Lake Macquarie City Council s support of the project? Please provide a list of the ways in which your organisation will acknowledge Council s funding support (For example, inclusion of logo and funding acknowledgment on educational and promotional material, media release and coverage). Environmental Sustainability Grant Application Form 2018-19 Round One Page 7
16. Monitoring and evaluation How will you monitor/evaluate your project? How will you know if it is a success? Looking at your answers to questions 10 and 11 above on key environmental and social outcomes of the project, how will you monitor/ measure achievement of these outcomes? (For example, size of area rehabilitated, size of area planted, number of native plants planted and established, installation of signage, number of people who volunteered their time to participate in the project, number of people who attended the event launch, number of people reached through promotion of the project to your wider community). 17. Consultation Please explain what consultation you have undertaken with relevant Council Officer/s in developing the project. Consultation #1 Council Officer s name: Date/s of communication: Context: Consultation #2 Council Officer s name: Date/s of communication: Context: Environmental Sustainability Grant Application Form 2018-19 Round One Page 8
18. Work plan Please list each works component of your project and the expected finish date. NOTE all projects must start and complete within 12 months of receiving grant funds. Project name: Proposed activity/task Expected finish date (mm/yy) Environmental Sustainability Grant Application Form 2018-19 Round One Page 9
19. Budget details *See grants website for extra help with project budgeting. ** Please make sure budgets are realistic. Please attach quotes to your application. For in-kind volunteer hours please provide a detailed breakdown (for example, task x number of people x number of hours x $30) so the committee can see your working. Council grant funds requested ($) Your organisation s matching funds In-kind ($ value) Other funding ($ value) Total project ($) Income A. Total income (add all income columns) (sum of Row A) Expenditure B. Total expenditure (add all expenditure columns) (sum of Row B) Balance (Row A Row B) (should equal zero) 0 0 0 0 Income includes all resources to be utilised for the project grant funds, cash and in-kind (for example, donation of goods or labour) Council grants funds requested are the grant funds sort from Council via this application Matching funds are the cash and in-kind contributions for the project that Council does not provide In-kind voluntary labour should be costed at $30/hour (please show calculations for example task, people, hours x $30) Expenditure should list all items/activities that the cash and in-kind support will contribute to (for example materials,promotion, labour, travel, contractors etc) Environmental Sustainability Grant Application Form 2018-19 Round One Page 10
20. Signatures Grant applicant - two representatives from the executive must sign We declare that the information we have given in this application is complete and correct and the organisation we represent supports the project. Name: Position: Organisation: Date: Signature: Representative 1 Representative 2 Sponsoring organisation - two representatives from the executive must sign (if applicable) We declare that the organisation we represent agrees to sponsor the project and to enter into a Funding Agreement for the Environmental Sustainability Grants Program with Lake Macquarie City Council and to administer the Agreement on behalf of the applicant. Name: Position: Organisation: Date: Signature: Representative 1 Representative 2 Additional pages may be attached to the application as required. Environmental Sustainability Grant Application Form 2018-19 Round One Page 11