Western Region Small Land Management Grants

Western Region Weeds Program – Application Form

Western Region Small Land Management Grants

Application form for training activities

Please read the Western Region Small Land Management Grants Guidelines and Conditions for community activities before completing this application form.

Part A – Self assessment checklist

Part B – Applicant details

Part D – Project details

Using the table below, please provide approximate numbers against each of the outputs Local Land Services must capture:

Number of training sessions, workshop seminars or skill training events

Number of participants who will attend

Number of Aboriginal community members involved

Total hecatares represented by farming entities present at the event

Where possible, estimate the number of media opportunities (radio, newspapers etc) that may occur

Part D – Project budget

Please outline entire project costs, including labour, with quotes supporting purchased items. If the calcuated LLS contribution exceeds $5,000 (excluding GST), then this figure will be taken as the maximum fundable amount.

Activity/Item/Product / Quantity / Cost per item
(GST excl.) / Total cost
(GST excl.) / Applicant In-kind / LLS contribution / Quotes Provided?
(insert activity/item/product name – delete this text) / $ / $ / $ / Yes ☐No ☐
(insert activity/item/product name – delete this text) / $ / $ / $ / Yes ☐No ☐
(insert activity/item/product name – delete this text) / $ / $ / $ / Yes ☐No ☐
(insert activity/item/product name – delete this text) / $ / $ / $ / Yes ☐No ☐
Total / $ / $

Western Region Small Land Management Program – Application Form

Part E – Hazard identification and risk assessment

Please outline risks to operators or the environment in undertaking this project. Add additional rows if you require.

Activity/item/product / Hazard description / Probability / Proposed risk controls
(insert activity/item/product name – delete this text) / (insert a description of the hazard associated with the activity/item/product – delete this text) / (insert a rating of the probability associated with the hazardeg, unlikely, possible, likely – delete this text) / (insert an explanation of how you will control the risk – delete this text)
(insert activity/item/product name – delete this text) / (insert a description of the hazard associated with the activity/item/product – delete this text) / (insert a rating of the probability associated with the hazard eg, unlikely, possible, likely – delete this text) / (insert an explanation of how you will control the risk – delete this text)

Please outline events or risks that may influence the successful completion of this project. Add additional rows if you require.

Event/risk / Impact on success / Probability / Proposed risk controls
(insert event name – delete this text) / (insert a description of the impact associated with the event – delete this text) / (insert a rating of the risk associated with the hazard eg, unlikely, possible, likely – delete this text) / (insert an explanation of how you will control the risk – delete this text)
(insert event name – delete this text) / (insert a description of the impact associated with the event – delete this text) / (insert a rating of the risk associated with the hazard eg, unlikely, possible, likely – delete this text) / (insert an explanation of how you will control the risk – delete this text)

Western Region Small Land Management Grants Program – Application Form

Part F – Other information

Part G – Applicant declaration

Lodge your application:

Preferred method – Email:

Other method – Post: Western Region Small Land Management Grants Program, PO Box 342, Bourke NSW 2840

The Small Land Management Grants Program is delivered by Local Land Services Western Region through funding from the Australian Government National Landcare Program.