Application worksheet

Individual Organisation (*required)*

First Name*

Last Name*

Phone number**

Email (please note, email is our preferred method of communication)*

Address**

This application is for a project, initiative or programme which demonstrates, promotes or achieves waste minimisation by promoting a circular economy for waste, and/or by supporting reuse, recycle and recover principles.*

This application is for a project, initiative or programme partially or wholly taking place within the boundaries of the Manawatū District.*

If this application is on behalf of an individual (as opposed to an organisation), the amount requested does not exceed $15,000 (exclusive GST).*

This application is not excluded by Section 5 of Council’s Waste Levy Grants Allocation Policy.*

Name of project, initiative or programme:*

Location of project, initiative or programme:*

Describe your waste minimisation project, initiative or programme (including its purpose and goals) Max 300 words*

Planned start date (dd/mm/yyyy)*

Planned end date (dd/mm/yyyy)*

Please tick all that apply Landfill waste What parts of the waste stream does your project, initiative or programme intend to address?*

Is access to all necessary waste streams secured? Max 300 words *required*

Describe your understanding of the risks involved with your proposed project, initiative or programme. Max 300 words *required*

Describe how your project, initiative would be funded in the long-term after Council grant funding has been used. Max 300 words *required*

Provide estimates of the scale of performance in terms of waste minimisation, how will this be measured? Max 300 words *required*

What benefits will be provided to the local and/or regional economy, to the wider Manawatū District community and the environment? Max 300 words *required*

If your application is for a pilot programme/trial, please provide an outline of testing, and business development of the end product/results of the project/trial. Max 300 words

How much of the Waste Not Want Not Fund are you applying for?*

Please ensure this application is not excluded by Section 5 of Council’s Waste Levy Grants Allocation Policy in respect of debt servicing, or funding for work already completed.*

Please note grants will not be subject to GST, all costs must be listed exclusive of GST.

Description $ (GST exclusive)*

Total expected income:*

Description $ (GST exclusive)*

Total expected costs:*

Please include at least two quotations for any expenditure for the purchase of equipment or materials. These can be attached to and submitted with your application form, or emailed to infrastructure@mdc.govt.nz with your application name as the subject line.

Total income amount (excl GST)*

Total expenditure amount (excl GST)*

Sum of Income minus Expenditure*

Please note, applications from individuals (as opposed to Organisations) must not exceed a total of $15,000 exc GST.

Have you applied to any other funders for this project? If yes, please provide details in the table below.*

Funder

Amount Approved

Date of Decision

Are you supplying any of the supporting documentation with this application?*

Please tick all that apply Bank Deposit Slip (*required) Other*

I am authorised to make this application, and I confirm that the information provided on the application form is true and correct. (Required)**

I have read and understand the Accountability requirements as outlined within the Waste Levy Allocation Policy, and agree to comply with these requirements should this application be successful. (Required)**

Should this application be successful, I agree to repay Manawatū District Council all funding that is not used for the purpose outlined within this application. (Required)**

I consent to Manawatū District Council collecting and retaining the contact details provided in this application and using these details for the purpose of assessment of this application. (Required)**

Signature of applicant*

Date*