. 6 .


COMMUNITY GRANTS PROGRAM
2015/16


APPLICATION FORM

Please complete all sections of this form.

Applicants are advised to refer to the document; Community Grant Program

Policy Guidelines.

SECTION 1: ORGANISATION DETAILS

Organisation/Club/Group:
Contact Person’s Name:
Position:
Address:
Phone: BH AH Mobile
Email:
Fax:

SECTION 2: BACKGROUND INFORMATION

2.1 What is the aim/purpose of your organisation or group:

2.2 Who do you provide a service to (your primary target group/s):

2.3 Briefly list the types of service/activities you currently undertake:


2.4 Does your organisation/group currently receive financial or in-kind support from Brighton Council? If yes then please provide details:

SECTION 3: PROPOSED PROJECT

3.1. Financial Details

Amount Requested $
Project Total $

3.2 Please provide your organisations ABN number

Are you registered for GST?

YES

NO

3.3. Program Categories

Please indicate the program category relevant to the proposed project:

Community Development

Purchase of equipment

Direct financial subsidies/Contribution

Minor capital grants


3.4 Project Name and Description seeking funding:

3.5 Describe how the money will be spent and give details about the project:

3.6 How will this project benefit the residents of Brighton?


3.7 If successful how will you ensure that Council gets appropriate acknowledgement:

SECTION 4: FURTHER INFORMATION FOR REQUESTS >$1,000

4.1 Please provide budget details for the project which you are seeking Council support: Provide additional pages if required.

INCOME:
$
$
$
$
TOTAL INCOME $
EXPENDITURE:
$
$
$
$
$
$
TOTAL EXPENDITURE $

4.2  Please provide a copy of your most recent audited financial statement

SECTION 5: DECLARATION

I declare that the above details are correct and I am authorised to sign on behalf of the organisation applying to the Brighton Council Community Grants Program:

Authorised Signatory:
Print Name:
Title:
Date:

APPLICATIONS CLOSE 12.00 NOON, 27th MARCH 2015.

Completed application forms should be sent to:
General Manager
Brighton Council
1 Tivoli Road
OLD BEACH TAS 7017
Enquires Cathy Harper 6268 7035