Trust Admin Use Only:
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Objectives
Attachments
Budget
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ENVIRONMENTAL TRUST
Environmental Research Program Application Form
Closing Date: 5pm 1 June 2012
General information
a)
Applications are by invitation only, based on expression of interest (EOI). You will need to read the
Environmental Trust’s Guidelines for Applicants for Major Grants. See www.environmentaltrust.nsw.gov.au or
phone (02) 8837 6093.
b)
Please answer every question. Where a question does not apply to your application, write ‘not applicable’ or
preferably briefly explain why.
c)
Grants available: Minor category up to $100,000. Major category, in general up to $200,000.
Section A – registration and administration
A1
Insert your reference number
Name of organisation
2012 / RD /
Project title
(maximum of 68 characters including spaces)
A2
A3
Minor categories
(maximum grant, $100,000)
Biophysical
or No
Social
Economic
Biodiversity and Conservation
Resource Efficiency and
Sustainability
Time frame - your project timeline and reporting to the Environmental Trust
Proposed start date
 Your project cannot start before 1 January 2013 but must start before
01 March 2013
 A progress report should be submitted for each year of the project.
Reporting dates should be at month end e.g. 30/11/2013
 Grants can be a maximum of 3 years duration
Submit progress report 1
Submit progress report 2
Submit final report
A5
Yes
Project category – tick the category that best describes your project. Tick only ONE box
Major category: Climate Change
(in general not exceeding $200,000)
A4
Is this project title the same as
your EOI project title?
Budget - amount you are seeking from the Environmental Trust
Year 1
$
Year 2
$
Year 3
$
 Major category grants in general should not exceed $200,000.
Minor category grants cannot exceed $100,000
Total amount requested
$
 These amounts must equal the amounts in section C1
 Note: if your project is more than a year in length, not all Trust
funding can be received in year 1
Geographic reach (either specify particular LGA/s, CMA areas and electorates or write ‘statewide’ if
your project has a statewide benefit).
Main Local Government area/s
A6
CMA area/s
Central West
State Electorate/s
1
Environmental Research Program 2012 – Application Form
A7
Yes
Has your organisation previously received Environmental Trust funding?
or No
If YES, please
provide project
reference number
or name of
project(s)
Applicant details
A8
Organisation’s details
Name of organisation
What is your ABN?
Registered for GST
Yes
or No
Postal address
Suburb
State
Postcode
Contact for correspondence - If University; provide Research Office contact
A9
Title
First Name
Surname
Position
Fax
Daytime phone
(0 )
A10
(0 )
Email
Contact details for Principal Investigator
Title
First Name
Surname
Position
Email
Daytime Phone
(0 )
Mobile
Fax
(0 )
Administrator details (only if being administered by a different organisation)
A11
Administrator
Name of organisation
Administrator’s ABN?
Registered for GST
Yes
or No
Postal address
Suburb
A12
State
Contact details for Administrator
Title
First Name
Surname
Position
Fax
Daytime phone
(0 )
A13
2
(0 )
Email
Nominate one primary contact for correspondence
Applicant
A14
Postcode
Administrator
Are the contact details above the same as the contact details in your EOI?
Environmental Research Program application form 2012
Yes
or No
Section B – details of project
Questions B1 – B5 (relevant to assessment criterion 1 ‘Relevance and originality’)
B1
Project description
Please describe your environmental research project in 100 words or less. (Please note that this summary
will be used for all promotional material relating to the grant, i.e. media, web site etc.)
B2
Please explain your reasons for developing this project (include comment on knowledge/information
gaps that the project seeks to fill) and why you/your team are best suited to deliver it.
B3
Who will benefit from this new knowledge? (Include reference to which decisions and decision-makers
this research will inform.)
B4
What tangible environmental benefits could result from this research?
Environmental Research Program 2012 – Application Form
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B5
What are the objectives of this project?
(Ensure you provide a list of objectives and not a list of activities and outputs).
B6
What is innovative or original about your project?
Questions B7 – B8 (relevant to assessment criterion 2 ‘Technical feasibility – soundness’)
B7(a)
4
Please describe your research method/experimental design.
(Include how you will monitor your progress against objectives, how you will analyse your data, and
quality assurance and quality control procedures).
Environmental Research Program 2012 – Application Form
B7(b)
What outcomes will your project achieve? Ensure these are measurable and tied to the project
objectives listed in B5.
B7(c) Summarise the literature and consultation used to develop your project
B8(a)
Please tell us your project timetable by year (or major stage) with dates against each task. Tell us
how you will measure progress each year (or stage). Activities in each year should relate to the
annual amounts requested (see section C1).
Year 1/stage 1
Activities
Team member(s) involved
Completion
date
(dd/mm/yy)
Submit first progress report (or final report) to Environmental Trust.
How do you propose to measure progress and determine if activities are working towards achieving your
objectives during the first year/stage?
Environmental Research Program 2012 – Application Form
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Year 2/stage 2
Activities
Team member(s) involved
Completion
date
(dd/mm/yy)
Submit second progress report (or final report) to Environmental Trust.
How do you propose to measure progress and determine if activities are working towards achieving your
objectives during the second year/stage?
Year 3/stage 3
Activities
Team member(s) involved
Completion
date
(dd/mm/yy)
Submit final report (or final report) to Environmental Trust.
How do you propose to measure progress and determine if activities are working towards achieving your
objectives during the final year/stage?
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Environmental Research Program 2012 – Application Form
B8(b)
What are some of the potential risks that could hinder progress on the project and how will you
manage them?
Risk factor
How risk will be managed
B8(c)
If you have applied to another organisation for additional funding for this project or wish to use
Trust funds as matching funds, please describe the likely impact on the nature or scale of your
project if that application is unsuccessful and how you intend to mitigate that effect.
Questions B9 – B11 (relevant to assessment criteria 3 & 5 ‘Dissemination’ and ‘Value for money’)
B9
Dissemination
In addition to the final report submitted to the Trust, how will you communicate the results of the research
to people who could benefit from this knowledge? Include who you will be targeting and also include your
communication expertise.
B10
Will any part of the research be ‘commercial-in-confidence’?
If the answer is ‘yes’, please provide an overview as to which parts are ‘commercial-in-confidence’ and
which parts are ‘public good’.
Environmental Research Program 2012 – Application Form
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B11
Commercial output
Will the results or product of the research be sold or licensed?
Unit cost
$
Retail price
$
Estimated number of sales/licences
Estimated profit (if any) from sales/licensing
$
Questions B12 – B15 (relevant to assessment criteria 4 & 5, ‘Project team’ and ‘Value for money’)
Project team – include people who will communicate results. Refer to page 6 of the Guidelines for Applicants
for Major Grants before completing questions B12 (a), (b) and (c).
Appropriate answers to be entered in the ‘Paid by whom?’ column are: Trust, Applicant, Combined or Other.
You should submit a CV for all people who are conducting the research.
B12(a)
Project leader(s)
Name
B12(b)
Job brief/
CV attached?
Job/function
Paid by
whom?
Job brief/
CV attached?
Job/function
Paid by
whom?
Job brief/
CV attached?
Consultants/subcontractors
Name
8
Paid by
whom?
Project employees
Name
B12(c)
Job/function
Environmental Research Program 2012 – Application Form
B13
What selection criteria will you use to employ each project staff member and who will be making
the selections?
B14
What in-kind contributions (e.g. advice, analysis, equipment, labour) are being made to this
project, either by your own organisation or by another? (Please include estimated value)
Name
(e.g. applicant, other organisation)
Job/function
$ Value if
applicable
B15
Please declare any real, potential or perceived conflict of interest you may be aware of and how
you intend to manage the conflict. (Refer to page 9 of the Guidelines for Applicants for Major Grants)
B16
If applicable, please list any specific issues from the EOI process that you were asked to address
in your application and detail how you have addressed them. Please include both the question
asked and your response.
Environmental Research Program 2012 – Application Form
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B17
It is a condition of your grant that you have adequate insurance cover including public liability
insurance of $20 million, workers compensation and volunteer insurance. Please provide details of
your insurance(s) below.
Company
Policy No/s
Coverage
Currency (expiry date)
Section C – financial information
This part of the Application Form is a separate Excel document and can be downloaded from our website.
See ‘Application Form Excel – Financial Section’ www.environmentaltrust.nsw.gov.au.
Please complete the Excel document and submit it with this Application Form.
Section D – referees
We require two referees who can assess your project as part of the Trust’s peer review process. They must be
available in the period 18 June to 13 July 2012. Referees should be external to your organisation and not
actively involved in the project and be able to attest to your organisation’s capability to undertake the project, and
the merits of the project.
Referee 1
Organisation:
Name:
Phone no:
(0 )
Mobile
E-mail:
Title/position:
Fax no:
(0 )
Referee 2
Organisation:
Name:
Phone no:
(0 )
Mobile
E-mail:
Title/position:
Fax no:
10
(0 )
Environmental Research Program 2012 – Application Form
Section E – authorisations
APPLICANT
Community: Include the names of two office-bearers in your organisation (e.g. Chairperson, Treasurer, Chief
Executive Officer or Executive Officer) who are able to attest to the accuracy of the information in the application.
Government: Include the name of your General Manager or Chief Executive Officer who can attest to the
accuracy of the information in the application.
University: Include the name of the Head of School/Department AND Head of Research Office who can attest to
the accuracy of the information in the application.
Applicant authorisation 1
Applicant authorisation 2
Organisation:
Organisation:
Name:
Name:
Position:
Position:
Date:
Date:
ADMINISTRATOR (only necessary if the grant is being administered by another organisation)
Please provide the name of a senior manager within the administering organisation who can confirm that the
organisation is prepared to act as administrator should the application be successful.
Administrator authorisation
Organisation:
Name:
Position:
Date:
Section F – inquiries
For any inquiries please contact:
Street Address:
The Program Administrator
Environmental Trust
Level 2, 1 Fitzwilliam St,
PARRAMATTA NSW 2150
Phone:
(02) 8837 6093
Email:
[email protected]
Environmental Research Program 2012 – Application Form
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Section G – submission details
Use the following checklist to make sure that your application is complete and accurately represents your project.
You should read the Guidelines for Applicants for Major Grants, particularly those sections covering the
objectives of the Trust and the program, eligibility, assessment criteria and GST.
Grant application check list
Answer all the questions in the application.
Type only in the spaces provided in the application form. The boxes provided for answers to questions
are a set size; the boxes will not expand to accommodate additional text if you continue to type beyond
the bottom of the text box. Please ensure answers to questions are fully contained within the limits of
the text boxes. Do not make your application longer than 10 pages.
Complete and attach Section C – Financial Information to this document.
If applicable, attach only A4-size maps and pages, and clearly show the location and size of the area
(including a scale).
Attach all required supporting information: CVs (curricula vitae, maximum 2-page summary), briefs
and job descriptions, letter(s) confirming other funding. Additional information should be kept to a
minimum.
DO NOT fax any part of your application.
Submit your application by the closing date – 5pm 1 June 2012.
Submit your entire application by ONE of the methods below. (i.e. DO NOT email AND post)
[email protected]
Email to:
 If emailing your application, ensure you email
your entire application, including all
attachments, e.g. maps; CVs. Trust staff will
not attach posted information to emailed
applications. Therefore, if you cannot email
your entire application, including attachments,
please use post or hand delivery.
 NB: Emailed applications must not be larger
than 10MB including all attachments.
 Please email the application form as a Word
document and the budget spreadsheet as
an Excel document (DO NOT PDF).
Attachments can be emailed as Word, Excel or
PDF documents.
The Administrator
Environmental Trust
PO Box 644
PARRAMATTA NSW 2124
Post to:
Hand deliver to:
Environmental Trust
Level 2, 1 Fitzwilliam St
PARRAMATTA NSW 2150
 If posting your application please send
2 copies of your application form and
attachments to the Trust.
 Do not bind or staple your application or
attachments. Colour printing is not required.
 If hand delivering your application please
deliver 2 copies of your application form and
attachments to the Trust.
 Do not bind or staple your application or
attachments. Colour printing is not required.
Any Application that is late, incomplete or ineligible will not be considered.
Published by the NSW Environmental Trust, PO Box 644, Parramatta 2124 Phone: 02 8837 6093 Fax: 02 8837 6099
Email: [email protected] Website: www.environmentaltrust.nsw.gov.au OEH 2012/0005 December 2011
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Environmental Research Program 2012 – Application Form