2016APPLICATION FORM

Community and Philanthropy Partnerships Week

Applications close 5pm,6 June 2016

Please read the guidelines before completing your application.

Enquiries can be made to FRRR on freecall 1800 170 020 or

See more information on applying, grantseeker FAQs and application tips!

ORGANISATION INFORMATION

Organisation Name
As appears on your ABN / Inc. Certificate
Postal Address / Town / State / Postcode
Website/s / Social media addresses
Facebook / Twitter/ etc.
ABN / Incorporation Number
Don’t know? Go to / You MUST attach a copy of certificate
or a print out of registration
GST – Registered / Yes / No
DGR – Deductible Gift Recipient
(Metro based organisations MUST have DGR status to be eligible) / Yes / No / Provide a copy of ATO Endorsement if applicable. Note that organisations based in rural, regional and remote areas are not required to have Deductible Gift Recipient (DGR) status.
TCC – Tax Concession Charity / Yes / No / Provide a copy of ATO Endorsement if applicable
Head of Organisation This person MUST sign the last page or application willnot be considered. e.g. CEO, President, Chair
Mr Ms Name
Position Held / Phone No
Email / Mobile
Second Contact for ApplicationPlease provide a second contact person, with separate contact details, who is familiar with the application
Mr Ms Name
Position Held / Phone No
Email / Mobile

PROJECT INFORMATION

Project Title
Make it catchy!
Grant Amount Requested
Maximum $10,000, use whole $ only / Population
Project location
Town Name
Project location / State
Project location / Post Code
Project location
Local Government Area
Project location
Proximity to nearest Capital City
Project location (e.g. 1450 km NE Perth, WA)
Federal Electorate in which the project will take place Don’t know? Go to
Category which best describes your projectPlease indicate one only
Culture / Economic / Education / Environment / Social Welfare / Health
Category which best describes the project’s target audience Please indicate up to three only
All Community / Adults / Older People (60+) / Families / Disabled & Carers
Children & Young Adults (0-25yrs) / Early Childhood
(0-5yrs) / Children
(6-13yrs) / Youth
(13-17yrs) / Young Adults
(18-25yrs)
Indigenous Australians / CALD / Men / Women / LGBTQI+
Does your project involve working directly with children/youth under 18 years? Please indicate one only / Yes / No
If YES, does your organisation have policies and procedures regarding working with children, Working with Children Checks, and the handling of child abuse complaints?Please indicate one only / Yes / No
TELL US ABOUT YOUR ORGANISATION:Provide a brief overview e.g. mission, founding date, programs and distinctive attributes, number of members, enrolments, staff, volunteers, etc. Halls, please detail use of facilities e.g. user groups, attendees, hrs of use per week/month, etc.
TELL US ABOUT YOUR PARTNERSHIPS:A strong partnership is one that is collaborative, has clearly defined goals and objectives, and shared roles, responsibilities and resources.
Who are your partners?
How long have these partnerships existed?
How do these partnerships deliver more than you could on your own?
In what ways are the partnershipscollaborative? Describe the shared goals and objectives, shared roles, responsibilities and resources.
TELL US ABOUT YOUR IDEA:Provide a project plan for your activities clearly demonstrating the roles and contribution of each partner and dates for activities.Refer to ourProject Planning Toolif you require a planning template.NB: You will not receive funds until September 2016 and we cannot fund retrospectively.
What exactly do you want to do?
How will it profile and celebrate your partnership?
When will the activities take place?
How will your partners be involved?
TELL US WHAT YOU THINK YOUR PROJECT WILL ACHIEVE: i.e. new collaborations, new volunteers, new donors and supporters, greater reach, deeper impacts.
How will this project grow your partnerships?
What are the anticipated outcomes and impacts, and how will you measure these?
What will be different in your community as a result of this partnership project?
Why is this important?

PROJECT FINANCES

DOES THE GRANT AMOUNT REQUESTED COVER THE FULL COST? YES NO

PLEASE COMPLETETHE BUDGET TABLE BELOW:Include all other contributions. Are these confirmed or pending? Provide quotes for costs and attach. Include a description of in-kind support in your budget, both WHO and WHAT they are contributing, e.g. discounts on quotes, waived hire, catering, project co-ordination, sponsorship etc. In-kind support is VERY highly regarded. Total income must equal total expenses.

PROJECT BUDGET(This table must be completed. Use whole $ only & insert more rows if required)
CASH INCOME / $ / CASH EXPENDITURE / $
CPPW Grant Request(as per $ requested on page 1)
Cash contribution from your organisation/partners
IN-KIND SUPPORT - WHO
Itemise the non-cash support for the project.
Who is helping and to what value? / $ / IN-KIND SUPPORT - WHAT
List & $ value of goods or services donated. Detail or breakdown this group/person’s support,
e.g. 4 hours volunteer time @ $25 = $100 / $
In-kind contribution from your organisation/partners
TOTAL INCOME(must balance total expenditure) / TOTAL EXPENSES(must balance total income)
APPLICATION CHECKLIST CERTIFICATION
ENSURE YOU HAVE COMPLETED THESE SECTIONS
and answered all questions on the form in full /
  • Organisation Information
  • Project Information
  • Project Finances
/ YES
YES
YES
ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material must be submitted with the application
  • OrganisationFinancials - either last audited statement OR current Profit & Loss/Balance sheet (ESSENTIAL)
  • Certificate of ABN or Incorporation - or attach printout from (ESSENTIAL)
  • Letters of support for project (optional, but very highly regarded)
  • Quotes to support budget items (optional, but very highly regarded)
  • Project Plan (if not contained within the application form)
  • Certification (see below) signed by legal head of organisation (may be submitted as a separate attachment)
/ YES
YES
YES NO
YES NO
YES N/A YES N/A
PLEASE COMPLETE THE BELOW CERTIFICATION - Must be signed by the legal head of your organisation or applicationineligible
I/We acknowledge and understand that all applications become the property of FRRR.
I/We acknowledge and understand that to be eligible, at least one part of the event/program/activity we seek funding for
MUST be heldduring Community & Philanthropy Partnerships Week,5 – 11 December 2016.
I/We agree to inform FRRR if the organisation has a significant change to its financial situation.
I/We agree if successful, to upload information relating to our activity on the CPPW website:
I/We agree if successful, to expend any funding by the end of January 2017, and will be expected to acquit the project by
28 February 2017.
I/We agree for FRRR & Philanthropy Australiato publish stories and photographs of CPPW projects funded.
HEAD OF ORGANISATIONMUST SIGN HERE or application will not be considered,e.g. Chair, CEO, President.
(This page can be printed, signed, scanned or photographed and attached separately to the application if electronic signature unavailable.)
PRINT NAME / SIGNED
POSITION / DATED
ORGANISATION NAME
CLOSING DATE
5pm,Monday 6 June 2016
Applications can be submitted by email (preferable) or post.
Please note, emailed application forms are preferred in WORD format. Attachments may be saved as PDF.
Mailed applications to be post marked on or before the closing date.
Email:
Post:Community and Philanthropy Partnerships Week Program, c/- FRRR, PO Box 41, Bendigo, Vic 3552
CPPW is supported through the Prime Minister’s Community Business Partnership and managed by
Philanthropy Australia in partnership with the Foundation for Rural and Regional Renewal.