2010-11

APPLICATION FORM FOR FUNDING UNDER THE GENDER EQUALITY FOR WOMEN PROGRAM

COMMUNITY ACTION GRANTS

Stream 2 – Sporting Codes

Information for applicants

Applications must be submitted or postmarked by:

5:00pm AEST30 May 2011.

Applications may be lodged by email (electronic).

Applications postmarked after the closing datemay not be included in the

assessment process.

Email (electronic) Applications

Applicants may apply by email through the email box

Paper based applications must be lodged at:

Community Action Grants

Tender Box,

Department of Families, Housing, Community Services and Indigenous Affairs,

Module B Reception,

TuggeranongOffice Park,

Athllon Drive

Tuggeranong ACT 2900

postmarked by the closing date specified above.

If you have any questions about this application form, please consult the application guidelines. If you cannot find the information you require please email phone the hotline (cost of a local call) 1300 138 494 between 9am – 5pm AEST Monday to Friday or please see New questions will not be accepted after 5 pm AESTMonday 23 May 2011.

National Relay Service (NRS)

If you are deaf or have a hearing or speech impairment, you can use the NRS to contact any of the Department's listed phone numbers. To access a 1300 FaHCSIA number NRS Speak and Listen users can phone 1300 555 727, and TTY users can phone 133 677, and then ask for our hotline number. Internet relay users can connect to the NRS (see for details) and then ask for the hotline number.

If you are completing this application form you should only proceed if you have read the program guidelines.Assessment of applications will be based on the information provided in the application guidelines.

Please note that FaHCSIA may use successful applicants’ information, other than personal information that has been provided in the applicants’ application, to assist FaHCSIA to:

(a)comply with the Australian Government requirement to publish the names of all funding recipients on the FaHCSIA website

(b)inform staff negotiating and establishing funding agreements of risks and issues which need to be addressed in the agreement for that program

(c)inform future assessments for applications in the same program, or

(d)inform assessments for applications for other programs.

Please indicate whether you agree to the department using the information (not personal information) you have provided in your application for the purposes listed at (a), (b), (c) and (d) above.

I agree

I do not agree

Part 1 Eligibility

1a. Organisation type and financial status

Is your organisation or lead agency non-government?

Non-government

Government

Is your organisation or lead agency not for profit? Not for profit For profit

1b. Organisation entity type

Please tick √ all applicable boxes.
Incorporated association
Incorporated cooperative
Aboriginal corporation
Organisation established through specific Commonwealth or state/territory legislation
Not for profit Company(Incorporated under Corporations Act 2001)

If you have not ticked any box from the list above, your organisation isnot able to apply for funding.

Part 2 Applicant details

2What is the legal name of your organisation?
This is the name that appears on all official documents and legal papers. It may be different to your trading name.

All further responses within this application form must relate to this entity.

This is the legal entity that FaHCSIA will enter into Funding Agreements with.

3What is the trading name of your organisation?
This is the name your organisation trades or provides services under.

4 Does your organisation plan to
subcontract any or all of the project provision, if this application is successful? / Yes No
If yes, successful applicants may be asked to provide details of those sub-contracting arrangements and the organisations involve
5 What is your organisation’s physical address? / Physicaladdress (not a PO box)
Building/floor
Street no.
and name
Suburb/town
State / Postcode
6 What is your organisation’s postal address?
Same as above / Postaladdress
Building/floor
Street no.
and name
Suburb/town
State / Postcode

7 What is the outlet name where the project will be delivered? (This question applies if the outlet name is different to the name in Q2 or Q3. If there will be a range of locations, such as schools or community locations, add additional locations in question 9.)

8 What is the outlet’sphysical address? / Physicaladdress (not a PO box)
Building/floor
Street no.
and name
Suburb/town
State / Postcode
9 If more than one outlet will be used to deliver the project please list
(If locations are not confirmed, please indicate that they are “proposed”) / Physicaladdress (not a PO box)
Outlet Name
Building/floor
Street no.
and name
Suburb/town
State / Postcode
Physicaladdress (not a PO box)
Outlet Name
Building/floor
Street no.
and name
Suburb/town
State / Postcode

10 Who are the authorised Contact Persons for this application?

Preferred contact

/

Alternative contact

Title

First name

Surname

Position in organisation

Telephone number

Mobile number

Fax number

Business email address

Part 3 Financial details

FaHCSIA is unable to fund your organisationif you do not provide bank account details.

11Does your organisation have an

Australian Business Number (ABN)? Yes No

If yes, what is the ABN of your

organisation?

If your organisation has an ABN

branch number, please provide it here.

12 Is your organisation registered for GST?
(Questions on GST requirements should be addressed to the Australian Taxation Office.) / Yes No
13 If you would like recipient created tax invoices (RCTIs) to be sent to an alternative email address to that of the preferred contact listed in Q10, please provide the new email address here. /
If this is left blank RCTIs will be sent to the preferred contact email address at Q10.
14 Please provide details of your organisation’s bank account for payment should your application be successful.
Record the account details of the organisation listed at Q3 only. FaHCSIA will not make cheque payments or payments to a third party. /
BSB number
Account number
Account name

Part 4Financial viability and governance

15 Please attach the following information (see Note below):
  • Your organisation’s most recent audited financial statements (with previous year for comparison)
Are these statements fully compliant with Australian accounting standards?
Yes No
If no, what is your rationale for preparation of financial statements which are not
fully compliant with Australian accounting standards.

  • a current financial statement (income and expenditure,balance sheet, and statement of equity - this statement does not need to be audited)
  • an income and expense budget, for the financial year for which funding is sought. (Excluding the funding being applied for in this application).
Note: If you have provided these documents to FaHCSIA as a requirement under an existing funding agreement you are not required to complete questions 15, 16 and 17. Please provide details at questions 18 and 19.
16 Please indicate if your organisation has the following
Please tick (√)where applicable
a)an organisation chart………………………………………………………
b)duty statements for all positions………………………………………….
c)financial policy and procedures (systems manual)…………………….
d)delegations, (authorised financial delegates…………………………...
or decision makers)
e)business plan……………………………………………………………. .
f)risk management plan……………………………………… …………...
g)minutes of board meetings……………………………………………...
As a part of our financial viability verification process you may be asked to provide copies of some or all of these documents.
Can you provide copies of these documents within 7 days of a request by us?
Yes No
17 Please tick (√) if any of the following apply to your organisation
  • Any form of litigation or enquiry during the past three years, current or pending.
    NOTE: If you have settled a claim on confidential terms, please indicate this
    in your response………………………………………………………………………
  • Any significant financial matter which may impact on the organisation
    e.g. insolvency or voluntary administration.…………………………………………
  • Future commitments or contingent liabilities that might materially affect the
    organisation…………………………………………………………………………….

If you have ticked any of the above (Q17) please provide a short explanation here
(further information may be requested).
(If you need to make this text box bigger to fit your answer press enter to make the space you need).


Part 5Program specific questions

Target groups

22Please list the project activities your organisation is proposing to deliver / Project activities
20Please list your proposed target groups here. / Proposed target groups
21Enter the state(s) or territory(ies) the proposed project will be provided in.
Enter the local government area(s) which will be covered by the proposed project.
Enter postcode(s) of the location which will be covered by your proposed project. / State or territory
Local government area
Postcode(s)
23Please estimate how many participants will be involved in this project / Estimated participants
24Please state the total amount of funding you are requesting for this project / Total funding requested

Part 6Responses to selection criteria

  1. Project activities and implementation

Describe the proposed project, the activities and how the project will be implemented within the proposed budget, to deliver value for money. Demonstrate how the budget for the project will ensure that the majority of the funding (at least 80%) will be used for project activities in local level sporting organisations, and the extent or reach of the project

  • Include information about how and where the project will be delivered and operate.
  • Describe the types of activities and how they will work to promote the primary prevention of violence against women.
  • Provide a budget for the project and information on the number of participants, proposed activities and other deliverables that will help determine value for money in social service delivery.
(These dot points are provided to assist you to develop your responses. You should add any additional informationyou believe will assist us to assess your application.)
  1. Project design and delivery

Demonstrate how your proposed project will use at least two (including item (b) below) of the following primary prevention approaches to reduce violence against women:

(a)Strengthen the community: examples include but are not limited to establishing mentoring groups with members of the sporting club and their families;

(b)Increase awareness in the community:examples include but are not limited to workshops, events, positive interviews with local sporting club members and website for online discussions; or

(c)Encourage community responsibility: examples include but are not limited to establishing zero tolerance initiatives within local sporting clubs, which may include funding to those local clubs which establish ‘no-to violence’ codes of conduct for those involved in the club.

  • Provide evidence for the proposed approach, including information from other projects where the approach has been effective.
  • Include how the approach you have chosen will reduce violence against women and meet the aims of the project.
  • Identify information about expected outcomes for participants and how you will measure the project performance.
(These dot points are provided to assist you to develop your responses. You should add any additional informationyou believe will assist us to assess your application.)
  1. Ability to reach local level clubs and organisations

Demonstrate your organisation’s ability to work with local level clubs and organisations to develop and deliver this project in local communities.

  • Tell us how your organisation would work with local level clubs and organisations to make the project successful.
  • Include information about how your organisation has worked with local level clubs on other similar projects.
  • Describe how local level clubs and organisations will be involved in the project design.
  • Include supporting letters from other community representatives noting support for the project.
(These dot points are provided to assist you to develop your responses. You should add any additional informationyou believe will assist us to assess your application.)
  1. Experience and expertise of your organisation, and qualifications of staff

Demonstrate that your organisation has the experience and expertise to develop or conduct a project to support the prevention of violence against women. Include information on how your organisation will ensure that the staff delivering violence prevention programs or activities will have the relevant qualifications, training, expertise and supporting supervision to conduct the activity. Demonstrate that your organisation has the competence and project management experience to support this project.

  • Provide details of your organisation’s experience in managing a project to support the prevention of violence against women (where applicable).
  • Provide details of either the skills and qualifications of current staff who would work on the project, or the skills and qualifications the organisation would recruit to support the project.
  • Provide details about how staff will be supported, and provided with supervision as required.
  • Provide information about the governance arrangements for the project.
  • Include any risks the project might face, and how the organisation would work to manage those risks.
(These dot points are provided to assist you to develop your responses. You should add any additional informationyou believe will assist us to assess your application.)
  1. Evaluation

Describe how your organisation will monitor and evaluate the project to assess its effectiveness. Demonstrate your organisation’s experience in monitoring and evaluating a project of this kind, including working with an independent evaluator. Describe how the evaluation results will be used to inform next steps beyond the life of the funding, and contribute to broader understanding and the evidence base for best practice.

  • Include information about how you would evaluate the project, and how this would be linked to the project design and activities.
  • Tell us how performance information will be used to evaluate the project.
  • Include information about how the evaluation for the project can be used to contribute information to the broader evidence base for preventing violence against women.
(These dot points are provided to assist you to develop your responses. You should add any additional informationyou believe will assist us to assess your application.)

Part 7Declaration

Please complete the declaration
NOTE:
Applications being submitted by post MUST be signed. / I declare that:
  • the information, including financial information, contained in this form is true and accurate,
  • I have read the programguidelines,
  • I have read, understood and accept the terms and conditions of funding and my organisation will be able to fully comply with those conditions.
  • I understand that incomplete applications may not be considered,
  • I agree to receiving recipient created tax invoices (RCTIs) for this funding should this application be successful,
  • if and where any personal details of a third party are included, the third party has been made aware of, and given their permission for, those details to appear in this application.
  • I am not aware of any perceived or actual conflict of interest that will arise by submitting this application. (For more information please see page 5 of Part B of the program guidelines. Describe below any conflicts of interest that have been identified).
Please describe any conflict of interest that may occur from submitting this application:

Signature / Date
Name (please PRINT) / Position in organisation

Funding agreement

Successful applicants must agree to and sign a funding agreement with the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA).

The terms and conditions of the Standard FaHCSIA Funding Agreement can be found from the Grants and Funding section on the department’s website:

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Part 8 Application checklist

To ensure that your application is complete, use the following checklist.

Part 1 / Eligibility: Have you responded to all relevant areas?
Part 2 / OrganisationDetails:Have you completed all the questions?
Part 3 / Financial Details: Have you completed all the questions?
Part 4 / Financial Viability:Have you provided the documents requested at Q15,
and completed all questions?
Short explanation to question 17 has been attached if required.
Part 5 / Program specific questions:Have you completed all the questions?
Part 6 / Responses to selection criteria: Have you addressed selection criteria 1
to 6, in this application, in line with theprogramguidelines?
Part 7 / Declaration: Have you read and completed the declaration carefully?
Part 8 / Application checklist (this part): Have you completed the application checklist?
General / For hardcopy applications, have you provided the original, 1 copy and
a CD (optional)

Note:applications that are incomplete may not be considered.

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