Environmental Management Fund Application Form Version 2

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1. Environmental Management Fund (EMF) Application

Project title*

Give your project a short, descriptive name

This project contributes to:*

Select the option(s) that best describe the outcome of your project

Mitigation response to adverse environmental scheme effects identified by GSWERP

Protect, enhance or restore native species, habitats, natural features, or historic or cultural heritage

Improve sustainable land and water management

Mitigate adverse environmental, social or cultural effects of the scheme construction or operation

Increase community understanding and involvement that contributes to sustainable management and healthy resources

Promote information/knowledge exchange of the natural management of rural communities

Resource investigation and scientific study

Complement landowner contributions and leverage contributions from other sources

2. About You or Your Organisation

Please provide the contact details for the person or organisation responsible for this application.

Organisation name*

(Or individual name if applying as a private landowner)

Contact person*

(The main person we should contact about this application)

First Last

Phone number*

Email address*

Legal status*

(e.g. company, trust, incorporated society, or community group)

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Legal status

(e.g. company, trust, incorporated society, or community group)

3. Project Details

Project type*

Select the option that best describes this project

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Geocoder

Project location

Please identify your project location by dropping a pin on the map below. Alternatively, if you are unable to use the map, you can manually enter the address of the location in the fields provided underneath.

Map

Provide the closest address or describe where the project is located*

Provide the closest address or describe where the project is located

Street Address Address Line 2 Town/City Region Post Code

Project category?*

Other description

Number of stems proposed to be established*

4. Project Overview

Project overview*

Provide a short overview of what you are planning to do and where the project will take place.

Project delivery*

Outline the key steps or activities involved in delivering the project.

Environmental outcome*

Describe the environmental issue you are addressing and the benefit your project will deliver (e.g. improved water quality, habitat restoration, erosion control).

How will you measure this?*

e.g. site inspections, photos, monitoring, before/after comparison.

Measuring success*

What will success look like? e.g. number of plants established, improved water clarity, reduced erosion.

Project duration*

Projects are expected to be completed within 12 months.

If a multiyear project

Briefly describe the wider project and how this stage fits within it.

Ongoing management*

Is there a maintenance plan in place?

Describe your maintenance approach

Tell us about your experience delivering similar projects. Include any previous work, or partnerships that will support the success of this project.

5. Permissions and Approvals

Do you have permission to undertake this project?*

Provide details of any permissions, approvals, or land access required.

Land ownership or access*

Select the option that applies to the land where the project will take place.

I/we own the land

I/we lease the land

I/we have permission from the landowner

Crown land

Māori land

Supporting documentation

Supporting documents will need to be uploaded at the end of this application.

If you own the land: Certificate of Title
If leased: Lease agreement
If using third-party land: Written landowner approval
If Crown land: Relevant Gazette notice
If Māori land: Māori Land Court documentation

How will they be measured?

6. Project Budget

Provide a breakdown of your project costs. Exclude GST if you are registered.

Materials to be purchased (provide quotes)

Exclude GST if registered

Supplier

Quote reference

Amount

Materials supplied by your organisation

Exclude GST if registered

Name

Amount

Project paid workforce

Calculate for the duration of the project.

Number of hours

Hourly rate

Amount

Other project costs

Exclude GST if registered.

Name

Amount

Other funding

List any funds received from any other sources for the project. Excluding GST if you are registered

Name

Amount

7. EMF project funding information

These fields are automatically calculated from earlier input

EMF funding applied for

excluding GST if you are registered

Your project contribution

excluding GST if you are registered

Funding from other sources

excluding GST if you are registered

Total project cost

excluding GST if you are registered

Supporting information

Upload any supporting documents for your application, such as quotes, plans, photos, approvals or land ownership documentation.

File upload

Drop files here or

Max. file size: 300 MB.

Consent

Consent*

I/We hereby declare the information supplied in this proposal is correct.
If the proposal is successful, I/we agree to:
(a) provide an accountability report (an accountability form will be sent to us in due course by Central Plains Water Limited) stating that the money received has been spent on the service agreed, including photos of the project within 12 months of the Commencement Date (Accountability Report); and
(a) execute the Funding Agreement provided to us by Central Plains Water Limited.
I/We acknowledge that Central Plains Water Limited will collect, use and share information and data about the Project, including personal information meaning information about an identifiable individual (Personal Information) (e.g. names of individuals, addresses, photographs or video content) (Data), to consider and assess our proposal.
I/We confirm that we have authorisation from the relevant parties to provide the Data.
Central Plains Water Limited may need to collect Data from, and share Data with, third parties for the purposes set out in paragraph 8.4, including, but not limited to, vetting. In some cases, those third parties may be located outside of New Zealand, but, where the Data includes Personal Information, Central Plains Water Limited will always ensure that it has in place safeguards comparable to those provided under the Privacy Act 2020.
To the extent that Data includes Personal Information, individuals have the rights to access and request the correction of that Personal Information in accordance with the Privacy Act 2020. Those rights can be accessed by contacting admin@cpwl.co.nz. There may be charges associated with exercising those rights.
I/We also consent to Central Plains Water Limited collecting and retaining the personal contact details of the persons listed in this application.

I agree to the proposal terms (below)*

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Environmental Management Funding

1. Environmental Management Fund (EMF) Application

2. About You or Your Organisation

3. Project Details

4. Project Overview

5. Permissions and Approvals

Supporting documentation

6. Project Budget

7. EMF project funding information

Supporting information

Consent

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Environmental Management Funding

1. Environmental Management Fund (EMF) Application

2. About You or Your Organisation

3. Project Details

4. Project Overview

5. Permissions and Approvals

Supporting documentation

6. Project Budget

7. EMF project funding information

Supporting information

Consent

Enter your details below.