Climate Resilient Communities Fund | Application Form

Closing date for applications is Tuesday, 29 October 2024

Please read the climate resilient communities fund guidelines before completing this application

Climate resilient communities fund guidelines

To help you plan your application, download a copy of this form in MS Word format. You can then type into it and when you're ready, copy and paste your text into this online application form.

Climate resilient communities fund application form (MS Word)

Save & Return

Use the 'Log in' button (on the right of your screen) to create a username and password so that you can fill in the form and save the data as you go. If you need to, you can sign back in and return to where you left off, without losing any information that you have already filled in.

To save your information, scroll to the end of the page and use the 'Save Progress' button. Remember to save before closing your browser.

1. Applicant details

Name of Organisation applying:
Must match the name on the bank account information supplied. *

Physical address

Street address: *

Suburb:

Town/city: *

Postcode: *

Postal address (if different from above)

Street address / PO box:

Suburb:

Town/city:

Postcode:

Applicants with no formal legal structure must nominate an umbrella organisation (which has agreed to receive and administer funds on your behalf).

Umbrella organisation administering project funding
The Umbrella organisation will be legally accountable to Northland Regional Council for fund expenditure.

Must match the name on the bank account information supplied.

Name (Umbrella Organisation):

Key Project contact person

Name: *

Position held in organisation: *

Daytime contact phone number: *

Email: *

Alternative Project contact person

Name (alternative contact):

Position held in organisation (alternative contact):

Daytime contact phone number (alternative contact):

Email (alternative contact):

Umbrella Organisation contact person

Name (umbrella org contact):

Position held in Umbrella Organisation:

Daytime contact phone number (umbrella org contact):

Email (umbrella org contact):

Bank account details

Must match the Organisation name (or Umbrella Organisation name) supplied.

Account name:

Account number:

GST registration (if registered):

2. Project information

Project name: *

Project location:
(Neighbourhood, Community, Town, District, Northland Region) *

Amount of funding sought:
The total funding available for any one application is between $5,000 and $40,000 excluding GST.
(Add N/A into the field that's not applicable). *

	Amount
Excluding GST	Amount
Including GST	Amount

Project summary:
Describe your project and what you hope to achieve. Include detail on:

How the project will benefit the wider community.
The steps you will take to make it happen.
How you will know if the project has been successful.

Which of the Climate Resilient Communities Fund priority impact areas does your project align to?
Select all priorities relevant to your project. *

Food resilience (Te Kai)

Water resilience (Te Wai)

Energy resilience (Te Ngao)

Nature-based resilience (Te Taiao)

Other (please provide detail) Other (please provide detail)

Who is your target audience?
Council prioritises communities most vulnerable to climate impacts and supports and equitable transition to community climate resilience.

Please provide any information on the vulnerability of your target audience to the impacts of climate change.

How many people do you expect to engage with or involve in this project?

Describe how you will encourage the community to take part.

Will any other individuals or organisations be supporting you on this project?

Provide names/organisation and how they will be involved.

Do you have aspirations or future plans to continue this work?

What will you need to make this happen?

Have you considered the possibility of negative consequences or future impacts of this work?
For example, planting large trees on a roadside berm may provide shade and biodiversity benefits, but could in future cause damage to power lines in a storm.

How will you measure the contribution of your project to a climate resilient community?
If successful, on completion of your project we will work with you to share the outcomes of your mahi (work). This story could include measurables like, greenhouse gas emissions reduced, waste reduction, increased biodiversity, reduced vulnerability or exposure to climate impacts. It could also include the number of people engaged with or the behaviour change achieved.

Describe some of the ways you intend to measure your success.

3. Project plan

When will the project take place?
The expected timeframe to complete the project is one year from grant of funds.

Start date: * +

End date: * +

Estimated timeframe for completing project outcomes:

Provide key milestones and expected dates for delivery. These may be used in providing further detail in the financial table.
Please complete as many lines as required.

🛈

	Task - what will you do?	Start date	End date
Milestone #1	Task - what will you do?	Start date	End date
Milestone #2	Task - what will you do?	Start date	End date
Milestone #3	Task - what will you do?	Start date	End date
Milestone #4	Task - what will you do?	Start date	End date
Milestone #5	Task - what will you do?	Start date	End date

Potential risks to the delivery of the project and how these would be managed:
Consider not meeting milestone timeframes, budget over-runs.

4. Budget

Deliverables:
Itemised list / Activity description (please provide details of quantities and costs per item). Please complete as many lines as required.

Please complete as many lines as required.

Note: For groups NOT GST registered, provide cost Excl GST; for groups WITH GST registration, provide cost Incl GST. 🛈

	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#1	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#2	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#3	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#4	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#5	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#6	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#7	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):
#8	Key deliverables description:	Delivery date:	Cost (Excl GST) :	Cost (Incl GST):

TOTAL FUNDING REQUESTED (INCL GST IF APPLICABLE):
This should equal the amount requested in section 2 of the application form. *

Add any further deliverables or supporting information (max 3 files): 🛈

In Kind Contribution to project management:
Contribution by applicant to the project. This may include financial contribution from other sources, or an in-kind contribution of goods or services, eg. volunteer hours, donated materials, advertising services.

This does not include the expected Volunteer hours from your target audience. For example, 50 people turn up to a planting day for 2 hours. We will ask you to report on this at the end of your project.

If Northland Regional Council is unable to fund your full request, would a smaller amount deliver some of your project?

What is the minimum amount you would need and which activities could you achieve?

3. Declarations

Conflicts of interest:
Enter details of any existing relationships that members/trustees of the applicant have with Northland Regional Council staff or Councillors. *

I/We certify that to the best of our/my knowledge the information contained in this application is correct: *

Yes

I/We certify that I/we have obtained the consent of all people involved to provide these details: *

Yes

6. Need help?

For any enquiries related to the preparation of your application, please contact:

Kim Wall
Climate Resilience Advisor, Northland Regional Council
Phone: 0800 002 004
Email: climateaction@nrc.govt.nz