Sponsorship and Donation Application Form

Forms can be submittedby mail or email to:

Port Waratah Coal Services

Community Investment and Partnership Programme

PO Box 57

Carrington NSW 2294

Email:

Part A – Details

  1. Organisation name: Click here to enter text.
  2. ACN/ABN: Click here to enter text.
  3. Postal Address: Click here to enter text.
  4. Street Address: Click here to enter text.
  5. Primary contact: Click here to enter text.
  6. Telephone: Click here to enter text.
  7. Email Address: Click here to enter text.

Part B – Project Information

  1. Name of project: Click here to enter text.
  2. Project description (aims and objectives):

Click here to enter text.

  1. When is the project expected to start or take place? Click here to enter a date.
  2. What direct community benefits will result from the project?

Part C – Eligibility

  1. If applicable, please attach and detail relevant indemnity information (e.g. landowner’s permission, insurance, ongoing maintenance responsibility).
  2. Does the work of your organisation provide political or personal gain? Yes ☐No ☐
  3. If so, please provide detail.

Click here to enter text.

Part D – Project Funding

  1. What is the value of funding requested from PWCS? Click here to enter text.
  2. What percentage of the total budget will PWCS be contributing to? Click here to enter text.

Part F – PWCS Involvement

  1. Are PWCS employees involved in the project? Yes ☐No ☐
  2. If not, is there a way for PWCS employees to be involved during the life span of the project?
  1. Are there any opportunities for the organisation to promote the involvement of PWCS if the application is approved?

Part H - Supporting Documentation

  1. Attach any documentation relevant to the project proposal that may assist in its approval (e.g. budget, references, detailed background information etc.)

Part J – Certification

I acknowledge that the information provided in this application, to the best of my knowledge is true and correct.

Signature: Date: Click here to enter a date.

Part K – Feedback

  1. How did you hear about the PWCS Community Investment and Partnership Program?

Part L – Approval Details (Office Use Only)

PWCS Sponsorship and Donation Application Form – Office Use Only

Date received:

Proposed amount:

Date submitted to committee:Approved/Not Approved

Date of Payment: