PRESERVING OUR ABORIGINAL SITES GRANTS PROGRAM

APPLICATION FORM

Applications must be received by the Department of Aboriginal Affairs by Wednesday 15 March 2017(Perth, Western Australia).

Add additional lines to each box below if additional space is required.

Applicant Details

Only one organisation must be listed as the applicant (if a grant is subsequently awarded it will be awarded to this organisation). In the case of joint submissions list the other organisations in the Project Details section of this form.

  1. What is the legal name of your organisation?
  1. Indicate what best describes your organisation.

Aboriginal CorporationIncorporated association

Unincorporated groupCompany (not-for-profit)

 Other (provide details below)

  1. Outline the reasons why your organisation is considered to be an Aboriginal organisation (attach relevant documentation such as certificates if applicable).
  1. Has your organisation ever been known by any other name?

 Yes No

If yes, what is the other name(s)?

  1. Provide your organisation’s contact details

Address

SuburbStatePostcode

PhoneMobileFax

Email

Website/URL

Postal address (if different to above)

Address

SuburbStatePostcode

  1. Who is the best person to talk to about the application if required.

Name

PhoneMobile

Email

  1. Does your organisation have an Australian Business Number (ABN) if applicable.

 Yes No

If yes, write your 11-digit ABN below.



  1. Is your organisation registered for GST.

 Yes No

Project Details

  1. What is the title of your proposed project?
  1. List any other organisationsthat will be involved in the project and their ABN/s (if applicable).
  1. List the Site ID as per the Department of Aboriginal Affairs’ records for all Aboriginal Sites that are the subject of this application. Refer to for information about registered Aboriginal Sites.

If you are submitting an application for places that are yet to be assessed as Aboriginal Sites under the Aboriginal Heritage Act 1972, list the Receipt ID for each Heritage Information Submission Formthat you submitted. If you do not know the Receipt ID, list the date that you submitted it and the location of the place.

  1. List the parcels of land that are subject of the application and provide evidence you will have appropriate authorization to undertake the works subject of the application if successful.
  1. Attach an overview of your proposed project (maximum fourA4 pages) describing the activities you for which you seek funding. Note that your application will be assessed against the following criteria and it is recommended that as part of your overview you state how your project will address these criteria:
  • sustainable long-term heritage benefits (50% weighting)
  • innovation, public benefit and increased awareness of Aboriginal heritage (30% weighting)
  • opportunities and benefits for Aboriginal people and organisations (20% weighting)

  1. What is the total amount of funding you wish to apply for? Incorporated organisations registered for GST can apply for a maximum of $50,000 (including GST) per application. Unincorporated groups and organisations not GST registered can only apply for a maximum of $15,000 per application

$

Submission

Completed applications can be emailed to or delivered by hand or post to:

Preserving our Aboriginal Sites Grants Program

Department of Aboriginal Affairs

Level 1, 151 Royal St

EAST PERTH WA 6004

A receipt notification will be sent to all applicants within one week of submission (generally via email). If you do not receive a receipt notification within one week of submission, please contact DAA via the above email address.

Applications must be received by the Department of Aboriginal Affairs by 4pm Wednesday 15 March 2017(Perth, Western Australia).