"Local Agenda 21 Environmental"
Local Agenda 21 Environmental Partnership Fund 2009 Application Form Closing date for submission of proposals: • Proposals for Local Agenda 21 Environmental Partnership projects should be submitted to the relevant local authority by Friday 12th June 2009. PLEASE NOTE THE FOLLOWING: 1. Commercial/business projects are not eligible for funding. 2. If making more than one application please ensure you use the same project title and full name in all cases. 3. In order to ensure that the fund prioritises locally identified environmental needs, it should be noted that no single project may apply to more than ten local authorities. 4. Approval of a grant application is conditional on tax clearance requirements being met. Where the combined total value of all your applications exceeds €10,000 nationwide, you are required to submit a copy of your current Tax Clearance Certificate with each application. 5. If this application for funding is successful, the applicant will be required to submit a brief report to the Local Authority on the achievements of the project before Monday 3rd May 2010. Failure to do so may jeopardise future funding under the scheme. 6. Projects deemed worthy of support might include community gardens, allotments and compost schemes, rainwater harvesting systems, ecological education initiatives and environmental exhibitions. Further information can be obtained from the Environment Awareness/Education Officer of your local authority or on-line at www.environ.ie 1. Applicant Details: Organisation Name*: ________________ Project co-ordinator: Address: Telephone: (home) (work) Fax: ________________ E-mail: _________________________________ * as per Tax Clearance Certificate Project Start Date: Completion Date: 2. Project Title 3. Purpose of Project 4. Describe nature of partnership with local community 5. Project Summary (a fuller description may be supplied separately with supporting documentation) 6. Projects should focus on environmental awareness and action which compliments national environmental priorities such as Waste, Biodiversity and Climate Change. What aspect of national environment policy is addressed by this project ? 7. Local Agenda 21 is a process which facilitates sustainable development at community level. How will this project contribute to developing Sustainable Local Communities”? 8. Summary of Costs and Funding: Costs Amount € € € € € € € Total € Sources of Funding Amount Amount sought from this scheme € Applicant Contribution € Other Source(s) – please specify details of donors etc. € € € € € Total € 8. Please indicate if you have made an application for this project to any other local authority. YES NO 8.1 If yes, please list the local authorities and amount sought (note maximum number of applications and Tax Clearance Certificate Requirements under items 3 & 4 above) Local Authority Amount Sought € € € € € € € € € € Total € 9.1 Please indicate if you have made an application for any other projects to any other local authority. YES NO 9.2 If yes, please list the local authorities and amount sought Project Local Authority Amount Sought € € € € € € € € € Total € Signed: _____________________ Date: _________________________ 10. Local Authority Details (For local authority use only) L.A. Name: Contact Name: Address: Telephone: Fax: ____ Signed: _______________________ Date _______________ Stamp of local authority: