Trust Admin Use Only / 2011 /RD/ / Organisation Y / N / Proof of non-profit status Y / N
(if applicable)

ENVIRONMENTAL TRUST

Environmental Research Program Expression of Interest Form

Closing Date: 5pm 11February 2011

General information

You should read the Environmental Trust’s Expression of Interest Guidelines and the Guidelines for Applicants for Major Grants prior to completing this expression of interest.

Please answer every question. Where a question does not apply to your proposal, write ‘not applicable’ or preferably briefly explain why.

Section A–registration and administration
Name of organisation
A1 / Project title (maximum of 68 charactersincluding spaces)
A2 / Project category –tick the category that best describes your project. Tick only ONE box
Major category: Climate Change
(in general not exceeding $200,000) / Biophysical / Social
Economic
Minor categories
(maximum grant, $100,000) / Environmental pollution / Integrated landscape management
A3 / Funding level - what level of funding (total funds over 1–3 years) are you seeking from the Environmental Trust?
If your organisation is registered for GST, make sure the budget is based on GST exclusive pricing (GST will be added if the project is approved). If your organisation is not registered for GST, make sure that the budget is based on GST inclusive pricing.
Less than $50,000 / $50,001 to $100,000 / $100,001 to $150,000 / $150,001 to $200,000
Over $200,000. Enter maximum amount: $
Note: Strong justification must be provided for projects seeking over $200,000. See question C8
A4 / Time frame –projects can start between 1 November 2011 and 1 February 2012
Proposed commencement date / Proposed completion date
(maximum 3 years duration)
A5 / Organisation’s details
Name of organisation
What is your ABN? / Registered for GST? / Yes or No
Postal address
Suburb / State / Postcode
A6 / Contact for correspondence - If University; provide Research Office contact
Title / First Name / Surname
Position / Daytime phone / (0)
Fax / (0) / Email

1Environmental ResearchProgram 2011 – Expression of Interest

A7 / Contact details for Principal Investigator
Title / First Name / Surname
Position / Daytime phone / (0)
Fax / (0) / Email
Section B - organisational structure

This section gives us important background information about the nature of your organisation and your organisation’s ability to manage your project. See page 1 of the Expression of Interest Guidelines for the eligibility of your organisation to apply for a grant.

B1 / What is the legal status of your organisation?(Select only ONE box)
Research institute (public) / Research institute (private – not for profit)
Community organisation

If you are a state or local government organisation, proceed to SectionC.All other organisations should complete the rest of this section.

B2 / Date of formation of your organisation / Registration no.
B3 / Office-bearers (if applicable)
Name / Position / Address
Are your office bearers: / ELECTED / APPOINTED
Is there a regular turnover of office bearers? / YES / NO
How many members are there in your organisation?
Can members of the public join your organisation? / YES / NO
Section C – project details
C1 / Problem / Issue to be addressed and why is this relevant
Describe the environmental problem or issue to be addressed and its significance for the NSW environment, environmental protection and/or nature conservation.
C2 / Project objectives - list the project objectives (ensure you provide a list of your objectives and not simply a list of activities and outputs)
C3 / Consultation on relevance of project - who have you discussed your proposal with to help determine:
a) the need for this project
b) whether or not this project duplicates existing work and
c) the usefulness of the output proposed?
Name and position / Result of consultation
C4 / List other current research on this topic, and name databases you have searched to obtain this information
C5 / Please outline your research methodology
C6 / List the expected outputs and environmental outcomes of the project
C7 / List details of your previous research in this or related fields, including journal references
C8 / If you have requested more than $200,000 for the major category please provide justification of why additional funds are needed for this project. Also explain what components would be excluded if a lesser amount was offered (note that projects must still be completed within 3 years of commencing).
Section D- authorisation
Person authorising submission of expression of interest
Include the name of your Chairperson, Chief Executive Officer, Head of Research, or senior officer who can attest to the accuracy of the information contained in this Expression of Interest.
Name:
Position in organisation:
Daytime phone: / (0) / Date:

Any Expression of Interest that is late, incomplete or not eligible will not be considered.

DECCW 2011/0012

Published January 2011

1Environmental ResearchProgram 2011 – Expression of Interest