Strength.Performance.Passion.

Lynwood QuarryCommunityInvestment Fund

Application form

2015to 2019

1. Overview

TheCommunity InvestmentFunddedicated totheMarulanandsurrounding communitiesisdesignedtohelpimprovethequalityoflifeofthemembersofour workforce,theirfamiliesandthecommunities. Wevaluelocalneeds,promote communityinvolvementandpartnerwithlocalstakeholdersaroundouroperations. Holcimhasdedicatedfundingand co-contributionsto improveeconomic,culturaland socialdevelopmentthroughoutthe region.Inadditionasapartofthecommunity we encourage and supportouremployees’engagementinvolunteeringand local communitywork.

2.Contact

Ifyouhaveanyquestionsregardingthefund,pleasecontacttheEnvironmentand

CommunityLiaison on1300 657 051or

3.Funding Application Form

Project Contact Details

Primary Contact

Name: ______

Position:______

Phone:______

Fax:______

Email:______

Address:______

Secondary Contact

Name: ______

Position:______

Phone:______

Fax:______

Email:______

Address:______

Organisation details: (must be incorporated)

Organisation name:______

ABN/ICN: ______

Insurance policy number:______Insurance company:______

Level of insurance:______

Project Details:

Project Name:______

Location (attach map if available): (must be within 20km of Lynwood Quarry) ______

Project Overview:

Please briefly describe the project (What are you planning to do)

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Please briefly describe the project objectives: (what will the project achieve)

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Please briefly outline the milestones that will lead to project completion. Please ensure dates are included for each milestone.

Milestone 1:

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Milestone 2:

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Milestone 3:

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Milestone 4:

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(Add milestones as required)

Criteriafor applications

Please provide information detailing how the project addresses the following criteria. Please insert additional lines if required. Note – Projects are assessed on the applicants responses to the below criteria. Not providing adequate information reduces the chances of a successful project.

CR1: The project must address at least one of the following criteria but can also address multiple. Please provide specific detail on how the project addresses the criteria pertinent to the project.

Providingeducationforsociety'sfutureincludes projectsrelatedto educational activitiesfor the widercommunity.

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Supportingsustainablecommunitydevelopmentincludesprojects related to communitydevelopmentactivitiesincollaborationwithlocal communitymembers and often NGOs – theseinclude projects/activitiesraisingthequalityoflifeandbuildingcapacityfor less privileged communitymembers.

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Building infrastructure for liveable communitiesincludes all spending related to the provision of liveable communities and promotionofcivicengagementsuch ashousing,transportation, sanitation, roads, bridges,canals, and recreationfor community members.

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CR2:Supportthesustainability ofsocial,environmentaland/oreconomic diversity,expansion orresilience oftheregion.

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CR3:CreateopportunitiesforHolcim to activelybe involved and help promote the project/activity.

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In addition:

CR4a:Forsubmissions greaterthan$2000pleasedetailapplicationsforany otherfundsorcontributionsfromotherorganisations(includinggovernment and non-government) orcommunitymembers.

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CR4b:Forsubmissionsgreaterthan $5000pleasealsodiscusstheimproved social,cultural or environmental outcomesexpected.

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Detailed Budget

Please provide a budget in the below table for all aspects of the project.

Holcim / Other
Item / Cost / Qty / Total / Cash / In-kind / Cash / In-kind
Example:
Star pickets / $1.85 / 50 / $92.50 / $50.00 / 0 / $42.50 / 0
Total

Budget explanation

Please provide any explanation required to provide sufficient details regarding the budget. This should include details of non Holcim in-kind and cash contribution and whether they are already secured.

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Other information

Please explain in detail how the project will promote Holcim and our contribution to the project:

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Please provide any information pertinent to return on investment considerations or value for money:

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Please include any other information pertinent to the project:

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