2013 Eco Schools Application Form

Trust Admin Use Only: / Attachments / Y / N / Budget / Y / N
Objectives / Y / N / Reference / 2013 / ES /

ENVIRONMENTAL TRUST

Eco Schools Program ApplicationForm

Closing Date: 5pm 17May 2013

Before you begin

Thoroughly read the Eco Schools Program – Guidelines for applicants, available on the Trust’s website at.

Please note: food gardens will not be funded from the Eco Schools Program. Please refer to new Food Gardens in Schools program on the above website.

Section A–general information
Name of school
A1 / Is your school registered on the Sustainable Schools NSW website?
To be eligible your school must be registered. Further information can be found on page 2 of the Guidelines for applicants. / Yes or No
A2 / Project title (maximum of 68 characters including spaces)
A3 / What is the main activity area of this project? Select ONLY ONEfrom the following choices. Please see the Guidelines for applicants for examples of eligible activities.
Water/stormwater
Grounds
Fauna
Waste
Outdoor learning area
Energy efficiency,
Aboriginal cultural project
Other – give details:
A4 / Project time frame – projects should be undertaken during the school year (i.e. February to December).
Project period starts: 1 February 2014 / Final report due:13December 2014
A5(a) / Geographic reach (specify particular LGA/s and electorates)
Main Local Government Area/s
State Electorate/s
A5(b) / What is the location of your project? (Latitude and Longitude co-ordinates can be taken directly from a map, or from Google Maps. Find your project location, right click and select ‘what’s here’. The co-ordinates will appear in the search box).
Latitude / Longitude

Eco Schools Program 2013 – Application FormPage 1

Section B – applicant details
B1 / School details
Name of school
What is your ABN? / Registered for GST? / Yes or No
Postal address
Suburb / State / Postcode
School phone / (0) / School fax / (0)
School email
B2 / Contact details for the person coordinating the project
Title / First name / Surname
Position / Daytime phone / (0)
Fax / (0) / Email
B3 / Contact details for an alternate person sharing coordination/responsibility for this project
Title / First name / Surname
Position / Daytime phone / (0)
Fax / (0) / Email
B4 / Name of any other school/community group sharing responsibility for this project (if applicable)
Name school / group
B5 / Name of the person who wrote this application and their relationship to the school.
Name / Relationship
B5(i) / School typeA (tick one)
Government
Non-Government / School Region/Diocese(if applicable):
B5(ii) / School type B (tick one)
Primary / Central
Secondary / Specific purpose
Environmental education centre / K-12
Other (detail)
B6 / Information about your school
Total no. of students / No. of staff
Section C – details of project
C1 / Project purpose- please describe your school environmental education project in100 words or less.Include the need for the project and how it will make a difference for the environment. (Note that this summary will be used for all promotional material relating to the project ie media, web site etc).
C2 / List the project’s objectives, outcomes and activities.
Please read the Eco Schools Program Guidelines for Applicants objectives before answering this question. (Note your school will be required to report against this activity at the completion of the project).
Project objectives.
(goals) / Outcomes
(what will
success look like?) / Activities
(these should be measurable) / Timeline
(by when?)
C3 / If your project is not within the school grounds, where is it located and who owns the land?
If the land is not owned by the school, please confirm that you have permission to work on it
(if applicable).
C4 / How will the project involve students and what will they learn?Please be specific about which students are involved and how teachers are engaged in the project.
C5 / How does this project relate to yourschool management plan?
Please attach an extract (A4 size only)or equivalent documentation that clearly identifies links between this project and the school management plan.
C6 / Describe the teacher professional learning or other staff developmentthat is required to implement the project.
C7 / How willthe local community and/or other schools get involved?
C8 / How can your school ensure the successesof this project continue after this funding?
Section D – project budget

List the individual items (e.g. material, teacher professional learning, equipment etc.) on which you will spend the $2,500 grant. You will be required to report against this budget at the completion of your project.
List any contribution the school and/or local community will make towards your project and describe in-kind contributions and/or put a $ value where financial contributions are made.
List all costs associated with the project. The amount requested from the Trust should NOT include any amount of Goods and Services Tax (GST) which may be payable on a listed item.
Please round off all totals to the nearest dollar.
Some indicative costs have been provided for you at (include link), but you should obtain your own quotes as associated costs may vary locally

D1 / Project budget
School/community contribution
($ and in-kind contributions) / Environmental Trust funds
Items the grant will pay for (must total $2,500)
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
$ / $
TOTAL / $ / (Total must equal $2,500) TOTAL / $
SectionE - authorisation
E1 / Name of the Principal or head teacher who can attest to the accuracy of the information contained in this application. (Signature not required)
Name:
Position in school:
Date:
E2 / Is your school also applying for a grant to the Trust’s Food Gardens in School program this year?
Should your schoolbe successful in receiving bothgrants, please describe how yourschool would manage both projects concurrently. / Yes or No

Published by the NSW Environmental Trust, PO Box 644, Parramatta 2124 Phone: 02 8837 6093 Fax:02 8837 6099

Email: Website: OEH 2013/0146 March 2013

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