Community Activities EOI Application

Community Activities application

Expression of Interest application

Note: Please refer to the Community Activities Guidelines to complete this form

Name
Property name
Mailing address
Western lands lease number
Lot & DP (location of properties where knowledge will be applied - if known)
Telephone
Fax
Mobile
Email
Training/activity location
Activity dates
(include travel days)
I am already on the Local Land Services Western Region mailing list / 
Please add me to the Local Land Services Western Region mailing list / 

Business Details (if applicable)

ABN
Trading Name
GST Registered

I would like to lodge an expression of interest to:

(Please give a brief description of the type of training you propose to do).

Please describe how you will apply this knowledge to improve the management of natural resources, sustainable agriculture, biosecurity or cultural awareness outcomes in the Western Region:

What community groups are you involved with and how will you spread the information gained to others?

Budget

Fill out all that is applicable to your project

(Please refer to page 5of the Guidelinesfor information on how to fill in this table)

Activity to be undertaken and items to be purchased / Item / Cost per Item
(ExclGST) / Total cost
(ExclGST) / Contribution sought
Trainer/presenter fees
Venue hire
Catering costs
Information resource costs
Total

Local Land Services Western Region

Expression of Interest - Training Activities 2014

1300 795 299 western.lls.nsw.gov.au1

Community Activities application

Project Risk Management Table

Risk identified / Actions to manage risk
Low attendance at event
Poor engagement in workshop/event – participants leave early and/or don’t show much interest in the presentations.
Attendees don’t implement or share the knowledge they have gained from the event.
Other:

Local Land Services Western Region

Expression of Interest - Training Activities 2014

1300 795 299 western.lls.nsw.gov.au1

Community Activities application

Outputs to be achieved by the project:

Number of training sessions/workshops/seminars attended
Number of participants (for this application)
Number of workbooks, course notes or materials purchased

Media

Projects can be used as examples to other landholders in the region to promote sustainable agriculture,natural resource management or Aboriginal cultural awareness. Indicate if you are willing for your project to be used as an example by Local Land Services Western Region

YesNo

How did you find out about this program?

mailout  website radio TV  newspaper word of mouth
 Local Land Services Western Region staff Other:

Local Land Services Western Region office and staff that assisted you with the application:

Local Land Services Western Regionoffice:
Local Land Services Western Region staff member:

Applicant Declaration

I ______declare:

(PRINT NAME) (GROUP/ORGANISATION)

That the information provided in this application is complete and correct. I have read and understand the guidelines concerning this application and I have no other outstanding projects with Local Land Services Western Region.

Signed:Date:

Post: / Hand delivery:
Local Land Services Western Region
Community Activities
PO Box 342
Bourke NSW 2840 / To any Local Land Services Western Region office.

Local Land Services