TACKLING TOUGH TIMES TOGETHER

Application Form – Small Grants up to $15,000: Round 7

Open Wednesday, 5 October to Friday 25, November 2016

ORGANISATION INFORMATION

Organisation Name:
(As appears on your ABN / Inc. Certificate)
Postal Address: / Town:
State: / Post Code: / Social media:
Website: / Social media (other)
(You MUST attach a copy of certificate) / Don’t know? Go to
ABN / Incorporation Number:
GST – Registered / Yes / No
DGR – Deductible Gift Recipient / Yes / No / (Please provide a copy of ATO Endorsement if applicable)
TCC – Tax Concession Charity / Yes / No / (Please 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 Application(Please 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 $15,000) / Town Name:
(Project location)
Population:
(Project location) / LGA: / Post Code:
(Project location)
State & proximity to nearest Capital City:(Project location) / (eg: 110km NE of Brisbane, QLD)
Program Objective your program seeks to address(Projects must fit within at least one of these)
Improving community connectedness and
social wellbeing / Support and engage the community in leadership development and skills training
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 / LGBTQIA
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
Does this project involve working directly with children/youth under 18? Please indicate one only / Yes / No

PROJECT INFORMATION

  1. TELL US ABOUT YOUR COMMUNITY i.e. demographics, employment, community activities, networks/clubs/organisations, economics, community & cultural diversity, festivals/events, recent declared natural disasters etc.

  1. TELL US ABOUT YOUR PROJECT.What is the need it addresses and what would the grant funds be used for? Where will it happen? Who will benefit?

  1. HOW WILL THIS PROJECT HELP YOUR COMMUNITY COPE WITH DROUGHT? How will your project help either improve community connectedness and social wellbeing or support, or engage the community in leadership development and skills training?

  1. WHEN WILL THE PROJECT HAPPEN? Outline the key dates – when will it start, expected completion, any project milestones. NB: FRRR cannot fund retrospectively.

  1. HOW WILL YOU MEASURE & COMMUNICATE SUCCESS? How will you know the project is successful? How will you undertake evaluation and/or outcomes measurement? Have you planned project outreach? If possible, provide measurable numbers e.g. 10 enrolments in leadership course, 15 participants in wellbeing course. Feedback surveys of project participants/beneficiaries?

  1. DO YOU HAVE A PLAN FOR HOW YOUR PROJECT WILL BE SUSTAINABLE BEYOND THE GRANT?

PROJECT BUDGET

DOES THE FRRR GRANT AMOUNT REQUESTED COVER THE FULL PROJECT COST?Yes No

Please provide details of the project income and expenditure, including any confirmed or unconfirmed income and any contribution from your organisation – either cash or in-kind.

PROJECT BUDGET
INCOME / $ / EXPENDITURE / $
FRRR Grant Request (as per requested $ on page 1)
Cash contribution from your organisation
IN-KIND SUPPORT / $ / IN-KIND SUPPORT / $
In kind contribution from your organisation
TOTAL / TOTAL

APPLICATION CHECKLIST

ENSURE YOU HAVE COMPLETED THESE SECTIONS
Application Cover Sheet
Project Information
Project Budget
ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material MUST be submitted with the application
OrganisationFinancials- eithercurrent profit & loss / balance sheet OR last audited statement(ESSENTIAL) / Yes
Certificate of ABN or Incorporation - or attach printout from (ESSENTIAL) / Yes
Letters of support for project (OPTIONAL, but very highly regarded) / Yes No
Quotes to support budget items (OPTIONAL, but very highly regarded) / Yes No
PLEASE COMPLETE THE BELOW CERTIFICATION
MUST BE HAND-SIGNED BY HEAD OF ORGANISATION OR WILL BE INELIGIBLE FOR FUNDING
I/We acknowledge and understand that all applications become the property of FRRR
I/We agree that FRRR may provide this application to other potential funding sources
I/We agree to inform FRRR if the organisation has a significant change to its financial situation
I/We agree if successful to expend any FRRR funding within 12 months or as determined in the grant agreement
I/We agree for FRRR and donors to publish stories and photographs of grants funded
HEAD OF ORGANISATION EG. CHAIR, CEO, PRESIDENT
NAME: / SIGNED
POSITION: / DATED
ORGANISATION NAME:
(As appears on your ABN or INC. Certificate)
PLEASE SUBMIT YOUR APPLICATION, VIA EMAIL
or VIA POST, FRRR – Tackling Tough Times Together, PO Box 41, BENDIGO, VIC 3552.
Applications need to be clearly postmarked before or on the CLOSING DATE, 5pm Friday, 25 November, 2016
Note: EMAILED WORD DOCUMENTS ARE PREFERRED TO PDF FILES
Optional questions and
feedback on application process / On a scale of 1= Easy to 5= Hard, how would you rate this application?
Please estimate time taken to complete application in hours?