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Hunter Local Land Services Aboriginal Land Management and Capacity Building Grant Application Form – 2016-17

This form can be used for applying for funding under any Hunter Local Land Services (LLS) Grants Programs. Please refer to the Grants Program Guidelines for further information about the terms and conditions of applying for LLS funding.

Funding for LLS Grants programs is provided from a variety of sources including the Australian Government, New South Wales Government and Hunter Catchment Contributions.

1. PROGRAM DETAILSWhat LLS Grant Program are you applying for funds through?Note: Your application may also be considered for funding under other LLS Programs.

2. APPLICANT AND PROPERTY DETAILSApplicant (The name at the Applicant should match the name of ABN holder if provided)

Contact Person Mr/Mrs/Ms

Landowner(s) (if not applicant) Mr/Mrs/Ms

Is the applicant an Aboriginal or Torres Strait Islander individual or organisation?

Yes No

Property Address (Project Location) Applicant Postal Address

Postcode Postcode

Contact Details

Telephone Bus: Mob: Facsimile

E-mail

Project Location(This information should be on your Council rates notice)

Lot/DP

Parish

County

Area of proposed project Ha (in hectares – please check with your LLS officer if unsure)

Total Area of Property Ha

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Event Number(LLS office use only)

ABN and GST Status

Are you currently registered for GST?

Yes No

Registered Business name: …………………………………. ABN: ………………………………………

Are you an incorporated association?If not, either provide the name and ABN of the auspicing organisation, or write ‘pay supplier’ if you would like LLS to pay your expenses directly (no auspicing required for this option):

Yes No

Group name:

Group membership

Are you affiliated with an Industry, Landcare or community group

Yes No

Group name:

Property Planning

Do you have a current Property Plan Yes No

Production and ProfitabilityDo you intend to increase profitability and production through your project? Yes No

3. ABOUT YOUR ORGANISATIONPlease provide an outline of your group/organisation’s role in sustainable natural resource and land management:

How long has your Aboriginal group/organisation been operating for or the Aboriginal group/organisation that you are partnering with?

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3. Project DescriptionPlease provide a description of your project and the objectives you are aiming to achieve. Include your environmental, cultural, and social objectives.

General:

Environmental:

Social:

Cultural:

5. Project Description

Which LLS District is your project in? Lower Hunter

(Lake Macquarie, Newcastle, Port Stephens, Cessnock, Maitland & Dungog LGAs)

Upper Hunter(Singleton, Muswellbrook & Upper Hunter LGAs)

Manning-Great Lakes(Great Lakes, Gloucester & Greater Taree LGAs)

Note: Your application may also be considered for funding under other LLS Programs.

6. TECHNICAL ADVICE AND CONSULTATIONPlease provide details of what advice you have sought or consultation you have undertaken in developing your application.

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7. RELEVANT LAND MANAGEMENT EXPERIENCEPlease provide an outline of your experience in land management.

8. RELEVANT LAND MANAGEMENT RESOURCEPlease provide a brief outline of what project management resources your organisation has to implement the onground and complete the reporting component of the project, include details of any relevant training or qualifications.

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6. PROJECT PLAN

What are you proposing to achieve through implementing the project (outcomes)?

Examples: re-establish native vegetation; improve groundcover and pasture species composition,

raise community awareness

What works or activities will you undertake?Examples: Plant & establish 500 trees; 2km fencing to exclude stock from stream; install 5 stock watering points, control 2ha of lantana & blackberry

Completion date?(month & year)

(Implementation of projects must be

completed by 31 May 2017)

What maintenance will you undertake to ensure project success on the long term?

(Funded activities are generally required to be maintained for a minimum of 5 years see funding

conditions)

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7. PROJECT BUDGET WORKSHEETNote: For estimate purposes landholders/community groups should cost their in kind labour component at $30/hour.

All amounts on this page must exclude GST. LLS funding is provided exclusive of GST. Please see the LLS GST Fact Sheet for more advice on funding and the GST implications.

A B C D E F G HActivity Cost Funding Proposal

Proposed Activity

Examples of Activities:Purchase trees, plant trees, erect electric fence

Unit of Measure

Quantity Unit Cost

(excl. GST)

Total Activity

Cost (C x D)

(excl. GST)

LLS Funds Sought

(excl. GST)

Applicant’s Cash

Contribution

(excl. GST)

Applicant’s In-Kind

Contribution

(excl. GST)

Example 1 Purchase Trees each 100 $6.00 $600.00 $300.00 $300.00 $0.00Example 2 Plant Trees hours 8 $30.00 $240.00 $240.00Please input your proposed activities below

TOTALS

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NOTE: If required, an Excel version of the Project Budget Worksheet is available from your LLS Officer

8. MONITORING AND REPORTINGHow will you monitor whether your project is achieving

the Outcomes?(BOLD rows are mandatory)

Tick adopted monitoring techniques.

Frequency or due date

Photo-point monitoring Before and after photos of works Step Point transect for assessing groundcover Event evaluation sheets Attendance records Pasture composition quadrats Tree survival rates Final Report Grazing records/Plan

9. MAINTENANCEPlease provide details of how intend to maintain the project to ensure outcomes you are aiming for are achieved and maintained over the longer term.

10. ABORIGINAL CULTURAL HERITAGE AND CONSULTATION

Checklist Questions Yes No

Do you know of any Aboriginal sites or objects on your property or in the immediate area?

Are you aware of any Aboriginal history, stories or significant events that took place on your property or in the immediate area? If YES, please provide a brief description below.

Is your project area located near a river, stream, lake, wetlands or watercourse?

Does your project area contain any of the following landforms: rocky or sandy hills, mountains, claypans, caves, sandstone overhangs?

Will there be any native vegetation removed permanently?

Are you interested in planting any native vegetation on your property?

Will there be any ground disturbance involved in the project? If YES, please provide brief description below.

Is the property on private (freehold) land?

Do you give permission for relevant project information to be provided to the Local Aboriginal Land Council for the purpose of cultural heritage assessment?

Other Notes:

11. PUBLIC LIABILITY INSURANCEYes No

I currently have Public Liability Insurance and a copy is attached

If you currently don’t have this insurance coverage, are you willing to acquire $20 million public liability coverage, if you are successful?

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12. MAP OF PROPOSED PROJECT WORKSYour LLS case officer will be able to provide you with a map of your project area and works proposed for inclusion in your application.

You may also wish to provide photographs or a sketch of the proposed project site in the space provided below to support your application.

13. CONFLICT OF INTEREST

Outline any conflict of interest you may have with the business or any director or staff of Hunter LLS

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14. DECLARATION AND SIGNATUREBefore signing please ensure your application is complete in all sections as incomplete applications will not be considered.

Successful applicants will need to adhere to the terms and conditions outlined in the Program guidelines.

If a company or organisation, the applicant must be an authorised representative of the entity.

I,Name of applicant (please print)

as the applicant confirm that all details outlined in this application are true and correct.

Signature of applicant Date

If you are applying to undertake a project on land of which you are not the owner, the landowner must also sign the application for private holdings or the responsible entity must sign for public land. If the landowner or responsible entity is a company or organisation, the signatory must be an authorised representative of the entity.

I,Name of land owner or responsible entity (please print)

as the landowner (or responsible entity) grant permission for the applicant to undertake the project on the land and confirm that I will be bound to all details outlined in this application.

Signature of landowner Date

Submission details for each Program are presented in the Program guidelines.

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