Outgoing Sponsorship Application Form - South East Natural ...

NRM SPONSORSHIP APPLICATIONRef: 07/152 -2011-___APPENDIX 1. NRM OUTGOING SPONSORSHIP APPLICATION FORM1. PROJECT/ACTIVITY TITLEDescribe the NRM Project/Activity(20 words or less)2. APPLICANT DETAILSName of applicant2.1Legal name of organisation orindividualTrading name(if different to legal name)Contact person for applicationThis should be someone who has good knowledge of the project and can answer questions on the application ifrequired and is authorised by the group.2.2 Community group detailsTitleFirst NameLast NamePosition inorganisationEmail addressPh (daytime)FacsimileMobileAddressTownPostcodeHow have you beenauthorised to leadthis activity[1]

Applicant Identification & GST registration2.3 Australian Business Number (ABN)2.4Is your organisation GSTregistered?YesNo3. PROJECT DESCRIPTION3.1 Project description (max 500 words)Please provide a summary of the project outlining:a) The purpose of the project/activity/eventb) How does the project/activity align with the Board’s Management Action Targets (MATs)?(Refer to Part Two: Strategic Plan of the SE Regional NRM Plan for more information:www.senrm.sa.gov.au/PolicyPlanning/RegionalNRMPlan )c) How many people will be involved in the project/activity?d) How do you think the natural resources of the South East region will benefit from theproject/activity?[2]

3.1 AcknowledgementPlease provide a brief summary of how the project will acknowledge the sponsorship of the Board[3]

4. PROJECT BUDGETPlease use this table format, not a different spreadsheet layout. Volunteer labour is to be costed at $30/hr. If you have sought any quotes please attach copies withyour application.Description of item,quantity & cost per unitA. ApplicantcontributionAmountB.Other contributionsName of contributorC.Funding soughtTotal activitycostsTotal project costs (columns A + B + C)[4]

5. SIGNATURESAll applicants must fill in and sign the below.I/we the applicant declare that the information given in this application is complete and correctand that the group/organisation represented supports the project. I/we understand that theinformation provided in this application may be disclosed to the South East Natural ResourcesManagement Board and the assessment panel.Applicant group/individualName of representativePositionSignaturePhone numberDateThe table below provides confirmation by landowners or land managers that the project worksmay proceed on the site.I, the landowner/manager confirm that the project activities as described in this application mayproceed on my property and grant permission for South East Natural Resources ManagementBoard representatives or their agents site access for purposes of project assessment if required.Landowner/manager (if different from applicant)Name of landowner/managerName of signatory (ifdifferent)SignaturePhone numberDate[5]