Zoos Victoria International Conservation Grants Application Form

Please submit applications to

APPLICATION FORM: International Conservation Grants Program

Office Use Only

ZV Application
Reference No: / Date Received:
/ /

Applications for Zoos Victoria 2016 Conservation Grants are open from1 August to 30 September, 2015. Successful applicants will be notified by 31 October 2015 and projects are to be completed by 31 October 2016. Successful applicants will be required to provide final project reports by 30 November 2016. Points of clarification and completed applications should be addressed

PLEASE COMPLETE THE APPLICATION FORM IN ENGLISH.

SECTION 1: Project Summary
  1. 1 Project Specifics

Project Title:
Project Location: / Country: Specific Locality:
Organisation:
Organisation Status: / Registered charity Business entity Non-profit
Other (please specify)
1.2Personnel Details – Project Leader/s
Name / Position/Organisation / Telephone / Email (indicate corresponding email)
*Please add further lines as required.
1.3Project Organisation Details
Name of CEO / Website / Contact person (if different to above) / Number of full and part-time staff
1.4 Funding (in Australian dollars)
Total $ sought from ZV: / AUD$ / Total Project Budget: / AUD$
Description of Project (maximum 250 words)
Brief bullet points are welcome.
1.5Describe the location/context of the project, including community context.
1.6List the community driven threats to wildlife that the project targets.
1.7List the actions that the project uses to address the threats to wildlife.
1.8 List the tools used to engage the community in the new behaviour (may include conservation education, community participation, social marketing tools etc.)
1.9List the expected wildlife conservation scope of the project, i.e. does it impact at a species, population, habitat or ecosystem scale?
SECTION 2: Project Details (Wildlife and Community Outcomes)
NB: Responses to Section 2 must be limited to 4 pages of a minimum 12 point font. Title Page, budget and additional information are not included in this limit. Brief bullet points are welcome.
2.1Whatare the expected measurable outcomes of the project for wildlife?Consider short-term (< 1 year) and long-term measurements/indicators of success (> 1 year).
2.2 What are the expected measurable outcomes of the project for people?
2.3Describehow the project’s wildlife and community outcomes will be evaluated (project design).
Communications
2.4How will you share the project outcomes with other organisations and interested parties?
Probability of Success
2.5Summarise the relevant expertise and track record of the Project Leader, project team, and host organisation in delivering conservation outcomes.
2.6 Are there risks to successfullyundertaking the project and, if so, how will they be mitigated?
2.7Will the project outcomes be sustained once a grant from Zoos Victoria has been expended? If so, how?
SECTION 3: Project Budget
Please use this budget template, note any funds from other sources, and clearly indicate priority items. A timeline should accompany the budget (see Section 4).
Please note:
-Budget must be presented in AUD (Australian dollars).
-All funds granted by Zoos Victoria must be expended by 31 October 2016.
-Funding from Zoos Victoria will not exceed AUD.20,000 per project.
-If the budget includes salaries, Zoos Victoria will only support these for local/national organisation staff (not expatriate staff).
-Salaries must not exceed 40% of the funding requested from Zoos Victoria.
Budget Item (add additional lines as necessary) / Cost / Source of funding
(Place * to indicate if funds are secured)
Total funding sought from Zoos Victoria (AUD):

Zoos Victoria International Conservation Grants Application Form

Please submit applications to

SECTION 4: Project Timeline
Mark the months against the activities you wish to undertake.
Activity / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec
*Please add further lines asrequired.
SECTION 5: Additional Information
NB: This will not count towards the page limit
Please attach the following documentation to support your application
  1. Curriculum vitae of project leaders (maximum of 2 pages each)
  2. Letters of reference, recommendation, collaboration/agreements with other organisations and support from relevant range-state agencies (optional)
  3. Copies of permits (if applicable)

Zoos Victoria International Conservation Grants Application Form

Please submit applications to

SECTION 6: APPLICANT DECLARATIONS
To be signed by each Project Leader listed
I hereby declare that:
  1. The qualifications and experience of all personnel to lead this project are appropriate for the activities described in this application.
  1. I agree to discuss any proposed changes to the activities and/or personnel described in this application with the nominated Zoos Victoria contact person for this project.
  1. I agree to provide a brief six-month progress update to Zoo Victoria by 31 May 2016.
  1. I agree to submit a final report by 30 November 2016.
  1. I will provide copies of any reports, theses or publications arising out of the project; and will acknowledge Zoos Victoria’s assistance in any such reports and publications.
  1. I will provide information and images of this project to promote the initiative upon request.

Name:
Signature:Date:
Name:
Signature:Date:
Name:
Signature:Date:
*Please add further lines asrequired.
Successful applicants will be required to provide final project reports by 30 November 2016.
OFFICE USE ONLY: ZVENDORSEMENT
Endorsement of International Conservation Partnerships Manager
Name:
Signature:Date:
Project Leader Notified / Date: / / / Date of Funds Transferred: / /