Application worksheet
A printable version of Environment Southland - Biodiversity Community Group Grant's application questions, extracted from their official form. Use it to plan your answers - then submit through the funder's real form.
View the original PDF →Application worksheet
Biodiversity Community Group Grant Application Form
Environment Southland - Biodiversity Community Group Grant
This worksheet mirrors the questions on the funder's official application form. It is NOT the official form. Submit your final answers through https://www.es.govt.nz/about-us/funding-and-support/biodiversity-community-group-grants.
Use this form to apply for funding from our Biodiversity Community Group Grant. Please read the Biodiversity Community Group Grant explanatory information before completing this application form. All projects must be within the Southland Regional Council boundary.
1. Section 1 - Getting Started
Name of applicant organisation **
Organisation address **
Phone **
Email **
2. Section 2 - General information
GST Registered **
If yes, please provide your GST number
What is the legal status of your organisation? **
Is your organisation registered with the Charities Commission? **
If Yes, please provide your NZ Business Number (refer www.nzbn.govt.nz)
Site location / physical address*
Project location - Please identify the exact site location on a map and attach it to this form.*
Does the site currently have legal protection? **
If Yes, please indicate what type of protection the site has *
First name **
Last name **
Phone **
Role **
Land owner (if different from above)
Role **
Contacts*
Please supply two contacts from your organisation with a brief description of their roles and their mobile numbers.
3. Section 3 - Site details
Please note that an application can not be submitted without a minimum of three benefits being entered. If you need assistance with this aspect – please contact one of our team on 03 211 5115. If you would like to add additional benefits / outcomes – please include these in your project plan.
About your organisation*
What is the purpose of your organisation? **
How many people belong to the organisation applying? **
How many people would benefit from this grant? **
Please provide a minimum of three outcomes / benefits to the community that would be provided by this funding.*
Describe how each benefit or outcome can be measured and / or established as being achieved.*
4. Section 4 - Details
Outcome/benefit**
Measured by **
5. Section 5 - Project plan
Please note that project activities should be completed within the financial year in which funding is approved. If for any reason a project extends into the next financial year, a time extension must be obtained from Environment Southland before 30 April.
Please note that the Biodiversity Community Group grant will reimburse up to 70% of the project cost. This will be paid on completion of the project.
Please provide details based on our Year 1 costs and activities. Future years to be estimated in your project plan and budget documents.*
Project costs*
Please attach a copy of your project budget to this application form and quotes for materials or contractors etc.
Your budget must include:*
Total project cost*
Total applicant contribution*
Total contribution requested from the Biodiversity Community Group Grant*
Volunteer labour can be included at $30/hr up to a maximum of 30% of the project cost.
Other funding - Please advise if funding is being sought from other sources and if so how much, who from and when would funding be confirmed.*
6. Section 6 - Budget
Please include a detailed budget for year 1 and an estimate for any other years you are applying for.*
Total amount requested from Biodiversity Community Grant Dollar amount for Year 1* $*
How many years will you be requiring funding? **
What will the grant be used for?*
Please list the key activities from Year 1 of your project plan i.e. fencing, weed control.*
Documents to attach
- Project plan document
- Project budget
- Quotes for materials or contractors etc.
- Copy of landowner agreement (if landowner is not the applicant)
- Balance sheet from the previous financial year
- Map identifying the exact site location
Declarations
- By continuing with this application you certify that: The information you provide is true and correct to the best of your knowledge.
Signature
Date
Worksheet generated by All Too Human (alltoohuman.nz/grants). Source: official PDF. This is not an official submission form.