2008- 09Individual Application Form

2008- 09Individual Application form

Complete this application form if your project involves sport leadership training for yourself only.

Sport Leadership Grants for Women

Sport:…………………………………….State:………………………………

Funding requested: $...... (maximum $5,000)

______

Location of Individual (please tick one only)

Metropolitanor

Rural/remote

Category (please tick one only)

High performance coaching and officiating(national/international level)or

Indigenous womenor

Women in disability sportor

General sport leadershipor

Women from culturally and linguistically diverse backgrounds

Course area (please tick one only)

Coachingor

Officiatingor

Governance (board/committees)or

Management/administration

Closing date: Thursday 15 May 2008

Additional Information

How did you find out about the grant?

Club Development NetworkEmailWeb site

Sporting organisationLetterRadio

Other (Specify) ______

Are you a previous grant recipient?

YesNo

If yes, what year?

2002/03 2003/04 2004/052005/06 2006/07
2007/08

Have you applied for funding to another agency for the project you will outline in this application?

YesNo

If yes which agency/agencies have you applied through?

______

What is your age range?

18-28 29-40 41-52 52+

Contact Details

Individual Details

Title: …….Given name: ……………….Family name: ………………………..………....

Postal/street address: ……………………………………………….…………...………..…….

Suburb: ……………………………………..…...State: ……………..Postcode:..……..…

Primary Tel: ( )…..…………….………..Secondary Tel: ( )….…………………..……

Fax no: ( )………..……………………….……….

Email: ……………………………………………...…………………………………….………..

Current level of Classification/Coaching/Officiating Accreditation (if applicable):

…………………………………………………………………………………………………

Are you an Australian citizen or have you been granted permanent residence status?

Please tickYES NO

Supporting Organisation Details

Organisation name: ……………………………………………………………………………..

Contact Person: …………………………..………....

Official capacity/title: ……………………………………….…………………………………..

Phone: ……………………………………………….

Email: ……………………………………………….

Organisations must be in a sporting organisation affiliated with a sport that is recognised by the Australian Sports Commission to be eligible to apply

Full list available at

IMPORTANT INFORMATION

You will not be eligible unless all relevant information is enclosed with your application.

Letter of Support Information

Please ensure you enclose your letter of support from your supporting organisation. Details about this can be found in the Supporting Information section of the Grant Guidelines.

Proof of Course Information

Please ensure you enclose proof of course, course dates and costs.

Board of Directors Applicants

Please attach a page outlining your current and previous positions within the sport/organisation.

High Performance Applicants Only

Please attach a page outlining your history of coaching/officiating experience, based on events and competition history. High Performance applicants are expected to be at the National or International Coaching/Officiating Level.

Course Details

Course title: (6 words max)

.…………………………………………………………………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………

Course description: (200 words max)

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

If your courseextends past June 30 2009, please outline the components for which you are seeking funding – see Guidelines, page 4. (50 words max)

Overview of your supporting organisation: (50 words)

Where will the course be delivered?
City/town: ...... ………………………... State: ......

When will the course be delivered? (Course start date must be after 1st July 2008)
……………………………………………………………………………………………………

Can you completeyourcourse or componentapplied for by 30 June 2009?

YesNo

Can you acquit the funding applied for and provide a report to the ASC within 30 days of the completion of the project?

YesNo

Course Impact

How will the course benefit you, your supporting organisation and the community?

Participant:(100 words max)

Organisation: (100 words max)

Sporting Community (short and long term): (100 words max)

Budget

THIS LIST IS AN EXAMPLE ONLY – PLEASE USE TERMS THAT ARE APPROPRIATE TO YOUR APPLICATION

INCOME
eg: What funding are you applying for, what funding are you and/or your organisation contributing?

ITEM / AMOUNT
Sport Leadership Grants for Women (must be completed) / $
Individual Contribution / $
Organisational Contribution / $
TOTAL ANTICIPATED INCOME / $

EXPENSES

Eg: What items will be covered by the funding, what items will be covered by organisation or individual contribution? (See guidelines page 4 for what will be covered by grant funding).
Please list all costs individually (attach separate page if necessary).

ITEM – Funding from grant / AMOUNT
Eg - Course Fees / $
Eg - Travel / $
$
$
$
ITEM – Individual or Organisation contribution / AMOUNT
Eg - Meals / $
Eg - Accommodation / $
Eg - Materials (textbooks etc) / $
$
$
$
TOTAL ANTICIPATED EXPENDITURE / $

NO MONITARY PROFIT IS TO BE MADE FROM THIS GRANT

Financial
(for information and assistance please refer to Pg 5 & 6 of the Guidelines)

Goods and Services Tax, Australian Business Number and Bank Account Information

Name of applicant:

……………….………………………………………….………………………………………….

Goods and services tax (GST)

Are you GST-registered? (please tick)

YesNo

Australian Business Number (ABN)

Do you have an ABN?YesNo

If yes, please supply: (11 digits)

Applicant’s bank account details

Bank: ……………………………….Bank location: ………………………………..…..……

Account name: ………………………………………………………………………………….

BSB:(6 digits)

Account No:

Note:Bank account details provided must correspond with the individual that has applied for the grant.

Office use: Complete for successful applicants only

Amount approvedGSTTotal (including GST)

Recipient Created Tax Invoice Agreement

Between:

1Recipient

Name:Australian Sports Commission

Australian Business Number:67 374 695 240

Postal address:PO Box 176, Belconnen ACT 2616

2Supplier

Name: …………………………………………………………………..………………..

Australian Business Number: …………………………………………………………

Postal address: …………………………………………………………………………..

3Purpose of this agreement

The Australian Sports Commission and ‘supplier’ hereby agree that the Australian Sports Commission will issue recipient created tax invoices in relation to the supply of services under the Sport Leadership Grants for Women program by the ‘supplier’ for a period of time commencing at the date of this agreement until this agreement is terminated with the consent of both parties or is no longer effective as a result of the requirements for the issuing of a recipient created tax invoice no longer being met by the parties.

4Terms for issuing recipient created tax invoices

•The Australian Sports Commission will, within 28 days of the making, or determining the value, of the taxable supply issue to the ‘supplier’ a recipient created tax invoice in respect of that supply.

•The ‘supplier’ will not issue to the Australian Sports Commission a tax invoice in respect of that supply.

•The Australian Sports Commission acknowledges that it is registered for GST at the time of entering into this agreement with the ‘supplier’.

•The Australian Sports Commission will notify the ‘supplier’ if the Australian Sports Commission ceases to be registered for GST or ceases to satisfy the requirements of GSTR 2000/10.

•The ‘supplier’ acknowledges that it is registered for GST at the time of entering into this agreement with the Australian Sports Commission.

•The ‘supplier’ will notify the Australian Sports Commission if the ‘supplier’ ceases to be registered for GST or satisfy the requirements of GSTR 2000/10.

•The Australian Sports Commission will issue to the ‘supplier’a recipient created adjustment note where a supply made under this agreement is subject to an adjustment event (as defined by Subdivision 19-A of A New Tax System [Goods and Services Tax] Act 1999).

•All recipient created tax invoices or recipient created adjustment notes issued to the ‘supplier’ by the Australian Sports Commission under this agreement will contain all the necessary information as required under A New Tax System (Goods and Services Tax) Act 1999 and A New Tax System (Goods and Services Tax) Regulations 1999 (Statutory Rules 1999 No. 245).

5Execution of agreement

Signed by: ……………………………………….………………………………………………

Name: ………………………………………………………..……………………………...…….

Date: ……………………

To be completed by the Australian Sports Commission

Signed by: ………………………………………….………………………………………………

Title: ……………………………………………………………..………………………………...….
(on behalf of Australian Sports Commission)

Date: ……………………

Agreement

Terms and conditions

1The Australian Sports Commission (ASC) may accept or reject any application for a grant in its absolute discretion.

2If the ASC decides to make a grant to the applicant, the Grant will be made subject to these terms and conditions and an enforceable agreement between the ASC and the applicant comprising these terms and conditions will take effect upon the ASC paying the grant.

3The ASC will make a one-off payment to the applicant for the project identified in the application form above and for no other purpose.

4If the applicant is required to be registered for the goods and services tax (GST), the grant will be subject to GST.

5If the applicant is required to be registered for GST, before the grant can be paid the applicant must sign an agreement for the ASC to provide a recipient created tax invoice in respect of the grant (see Recipient created tax invoice agreement on page 1011). By entering the recipient created tax invoice agreement, the applicant is authorising the ASC to raise a tax invoice on the applicant’s behalf.

6If the applicant:

ais not required to be GST-registered but they have an ABN, this needs to be quoted on the appropriate form in the application, or 48.5 per cent of the funds will be withheld and forwarded to the Australian Taxation Office

bis not required to be registered for GST and they do not have an ABN, they are required to complete the ‘Statement by a Supplier’ form (found at or 48.5 per cent of the funds will be withheld and forwarded to the Australian Taxation Office.

7The applicantmust:

aperform the project and expend the grant by 30 June 2009 and in accordance with the details provided to the ASC by the applicant in the application form

bsign and return to the ASC a completed report form within 30 days of the completion of the project and no later than 30 June 2009

cmaintain complete and accurate records and accounts detailing the use and expenditure of the grant and provide access to these records and accounts by the ASC or its authorised representatives for the purposes of copying the records and auditing the applicant’s use and expenditure of the grant.

dadhere to the ASC’s Anti-Doping Policy. The ASC Anti-Doping Policy is available at

8Without limitation to any other rights of the ASC, if the ASC reasonably believes, at any time during or after the funding period, that the applicant:

ahas provided false or misleading information in this application;

bhas not performed, or will not perform, the project during the funding period; or

chas otherwise breached any of its obligations set out in these terms and conditions, then the ASC may by written notice require the applicant to repay to the ASC, at the ASC’s absolute discretion, all or part of the grant. The amount notified becomes repayable within 14 days of any such notice.

Agreementto Terms and Conditions

I the person making this application certify that the facts shown in this application are true and correct in every detail. In the event I receive a Sport Leadership Grant for Women, I will ensure that the grant will be used for the purpose outlined in this application. I understand that this is an application and may not necessarily result in funding approval. I have read and I accept the terms and conditions.

In submitting an application, I consent to being checked against the Australian Sports Commission (ASC) Anti-Doping Database.

The ASC collects personal information in the process of considering applications for grants and administering grants programs. The ASC may disclose details of successful applicants to Members of Parliament, the media andthe consultancy group selected to review the Sport Leadership Grants. The ASC may also upload your project information to the ASC website or use it as an example through ASC networks in future. The ASC will not otherwise disclose such personal information without consent except where the ASC is permitted to do so under the Privacy Act 1988. The ASC uses such personal information to promote its future activities. If you do not wish to receive information of this kind, you can email

Name: ...... ……………...... …....…………………….....

Signature: ...... ………….... Date: ...... ……………………......

Checklist

Have you completed the following?

Thoroughly read the guidelines

All questions in the application form

Australian Business Number (ABN) if applicable (page 8)

Goods and services tax (GST) if applicable (page 8)

Bank account details (page 8)

Recipient created tax invoice agreement if applicable (pages9 and 10)

‘Statement by Supplier’ form if applicable (from the ATO website)

Read and signed the Agreement to Terms and Conditions (pages 11,12 and 13)

Letter of support from your organisation attached

Proof of course – course details/flyer, course date and cost (page 5 or attached)

High Performance Applicants – one page summary of coaching/officiating

Board of Director Applicants – one page summary of current role

Made a copy of your application to keep

Closing date: Thursday 15 May 2008

Mail, fax or email the application to:

Sport Leadership Grants for Women

Women and Sport Unit

Australian Sports Commission

PO Box 176

BELCONNEN ACT 2616

Fax: (02) 6214 1073
Email:
Note – emailed applications must be personally signed (no electronic signatures) and sent as a scanned PDF file.