Assessment form template for councils

Modify this template to match your Local heritage fund project application form for applicants

Project name:
Project no:
Category in applicant form / Criteria / Score / Initials –
assessor / Initials –specialist / Comment
4. Funding eligibilityModify or add the eligibility criteria below to match your application form. / Assess the heritage listing for the proposed project application / 20
A heritage item or an item included in a conservation area are in the council’s local environmental plan / LEP item(s) in conservation area / /5
Supported by your council’s heritage advisor or other heritage specialist as being of heritage significance / LEP heritage listed item(s) / /5
An item listed on the State Heritage Register / SHR heritage listed item(s) / /5
Other / No heritage funding in the last five years / /5
Sub total / /20
5. Funding priorities
Modify or add categories to match your form / Insert the funding priorities for each category and assess the project against these priorities / 30
For heritage items in a well-maintained heritage streetscape or landscape setting / /6
For a heritage item or for heritage items with public access and visibility / /6
For urgent maintenance works to avert management risks, for example, to manage severe deterioration or avoid demolition or demolition through neglect / /6
For part of a heritage group or a precinct, such as a town centre heritage group, a building terrace group or a homestead complex / /6
For fire, service and access upgrades for Building Code of Australia compliance with ongoing or adaptive reuse of heritage items / /6
Sub total / /30
6. Common selection criteria
Do not change these common selection criteria / Assess the project against all these criteria / /30
Sustainable long-term heritage benefits / Project contributes to the long-term sustainable management of the heritage item / /6
Public benefit and enjoyment: community leadership / Project increases opportunities for learning, access and enjoyment; supports active community support, involvement and employment; supports regional economies; and encourages positive community attitudes / /6
Innovation / Project involves a high degree of innovation and creativity / /6
Capacity and commitment to undertake the project / Time, financial and management skills
Complete within funding timetable / /6
Optional criteria – seniors’ grant / Seniors’ grant request – documentation provided (pensioner or self-funded retiree)
** If included, will need to modify scoring for this section / /6
Sub total / /30
Assess the quality and completeness of the project application / 20
Project scope / /5
Project costings / /5
Photos / /5
Greater than dollar for dollar contribution / /5
Sub total / /20
TOTAL / /100

Other information

Funding / Amount
Assess the funding requested
Requested amount / $
Recommended amount / $
Project funding exclusions / $
Assessor’s summary comments / Name / Date
Specialist’s summary comments / Name / Date
Approvals required under the Local Government Heritage Act
If approved, any special project funding conditions (to be added to the funding agreement)
Examples:
  • Heritage specialist required for this project
  • To confirm paint colour scheme before proceeding
  • To confirm mortar composition before proceeding