ApplicantDetails

Your name
Position
Name of organisation
Address
State / Postcode
Phone number / Mobile number
Fax number / Email address

Which of the following best describes you, the applicant(s)?

☐ Individual or group ‘sponsored by’ incorporated group

☐ Incorporated group

☐ Unincorporated group

☐ Other ______

Do you have an Australian Business Number (ABN)☐Yes☐No ABN: ______

If your organisation is incorporatedplease provide number? ______

Indicate the type of activity you are applying for

Awareness raising events and activities

☐ Awareness raising events promoting Aboriginal cultural heritage

☐ Awareness raising events promoting natural resource management

☐ Facilitating a ‘Kids on Country’ natural resource management and Aboriginal cultural heritage event

☐ Other (please specify)

Training and skills development

☐ Leadership and mentoring skills training

☐ Awareness raising events promoting Aboriginal cultural heritage

☐Awareness raising events promoting natural resource management

☐Training and knowledge development in natural resource management

☐Facilitating a ‘Kids on Country’ natural resource management and Aboriginal cultural heritage event

☐Other (please specify) …………………………………………………………………………………..

Development of management plans

☐ Specific plans for management of flora and fauna

☐ Weed management plans

☐ Biosecurity plans

☐Plans for the protection of Aboriginal Cultural sites and ongoing management

☐Traditional cultural fire burns or bushfire management plans

☐Development of fire and season calendar, promoting cultural fire burns in local area

☐Other (Please specify) …………………………………………………………………………………..

Implement on-ground actions that improve the condition of natural resources or protect cultural sites on Aboriginal owned land

☐ Preserve and protect sites with Aboriginal culture and heritage value ☐ Protection of existing native vegetation

☐ Restoration or rehabilitation of degraded land

☐ Establishment of new native vegetation

☐ River and wetland area restoration and protection

☐ Other (please specify) …………………………………………………………………………………..

Project title
Project description
Project objectives
Background and justification
Anticipatedproject results
Implementing and managing the project
Target audience
Indicative timelines and stages / Milestone / Target date
Project completion / 30th June 2018
Budget – use template belowor attach Excel spreadsheet using similar format
Activity / Details / Proponent contribution / Other contribution / Funding sought from NT LLS
TOTAL / $ / $
TOTAL FUNDING APPLIED FOR / $
Monitoring and evaluation

Declaration

Please check that your proposal is complete, then read and complete the declaration below;

The information provided in this application is complete, true and accurate to the best of my knowledge. I have consulted with, and have the support of the organisation and other organisationslisted as contributors to this project.
Signature of proponent
Name of organisation
Date

Additional Information (required for on-ground projects only)

Site photos

1:Please provide photos of your project site to support your application

2:Click on the boxes below to insert a photo from your computer

3:If digital photos are unavailable please contact Northern Tablelands Local Land Servicesfor alternate methods

Photo 1 Photo 2Photo 3

Site Map

For fencing and/or revegetation projects the map will need to identify the location and area of waterway to be fenced; area to be controlled for weeds and revegetated and/or off-stream watering point.

If you are having trouble providing a map, please contact the project contacts listedin the Program Guidelines for assistance.

Internal Use Only / Date application received:
IRIS No: / Data entry:

2017-2018 Northern Tablelands LLS - Aboriginal Community Grants Program Application Page 1 of 6