ACT Council of Social Service Inc. (ACTCOSS)

Community Organisation Membership Application

Use this form if you are a not-for-profit community organisation. If you are a for-profit or government agency, or if you are an individual, please use other application forms available at

1. Organisation Contact Details

Organisation’sName:
Postal Address Line 1:
Postal Address Line 2:
Suburb: / State: / Postcode:
Phone (general): / Email (accounts):
Email (general):
Website:
Primary Contact: / Position:
Phone (direct): / Mobile:
Email (direct):
CEO/equivalent Name: / Position Title:
CEO Email: / CEO Mobile:

2. Privacy & Contact Preferences

Your organisation’s preferred contact method: / ☐Email ☐Phone ☐Post
Do we have permission to publish your organisation’s: / Name in our annual report?Yes / No
Name and link on our website?Yes / No

3. Core Business

Please select the options that best describe your organisation's core business.

☐Aboriginal &/or Torres Strait Islander peoples / ☐Employment services / ☐Mental health
☐Advocacy, social action / ☐Environment, climate change / ☐Multicultural, migrant services
☐Alcohol & other drugs / ☐Family & children's services / ☐Peak body
☐Arts / ☐Health / ☐Self-help
☐Community development / ☐Housing, homelessness / ☐Therapeutic services
☐Consumer voice / ☐Industrial &/or workforce issues / ☐Volunteers
☐Disability services / ☐Justice, corrections, legal / ☐Women
☐Education / ☐LGBTIQ / ☐Young people
☐Emergency relief, financial counselling / ☐Men / ☐Other: Click here to enter text.

4. Membership Fee

Please select your membership category but do notsend payment yet (see Application Process below). If your organisation is experiencing financial hardship, please let us know and we will look into alternative arrangements.

ACT Council of Social Service Inc. | 1/6 Gritten St, Weston ACT 2611 | Ph: 02 6202 7200 | |

ACTCOSS is committed to reconciliation, acknowledges the traditional custodians of the land and pays respect to elders past and present.

Annual Revenue / Fees
☐Less than $10,000 / $30
☐$10,000 - $50,000 / $70
☐$50,001 - $100,000 / $145
Annual Revenue / Fees
☐$100,001 - $500,000 / $290
☐$500,001 - $750,000 / $420
☐$750,001 - $1million / $455
Annual Revenue / Fees
☐$1million - $2.5million / $620
☐$2.5million - $5million / $760
☐$5million plus / $1060

ACT Council of Social Service Inc. | 1/6 Gritten St, Weston ACT 2611 | Ph: 02 6202 7200 | |

ACTCOSS is committed to reconciliation, acknowledges the traditional custodians of the land and pays respect to elders past and present.

5. Delegates

Organisational members receive two votes at the ACTCOSS General Meetings and elections. Please nominate two Delegates to vote on behalf of your organisation and receive ACTCOSS email correspondence. Delegates may be the Primary Contact and/or CEO listed on the previous page.

Delegate 1: / Position:
Phone: / Email:
Delegate 2: / Position:
Phone: / Email:

6. Required Documents for Application

Please include with this application an electronic copy (preferred) or hard copy of your organisation’s:

☐ Most recent annual report or financial report☐ Constitution

7. Pursuing ACTCOSS’ Vision and Objects

My organisation is seeking membership of ACTCOSS and pursues ACTCOSS’ vision and objects:
  • To live in a fair and equitable community that respects and values diversity, human rights and sustainability and promotes justice, equity, reconciliation and social inclusion
  • The elimination of discrimination on the grounds of political affiliation, race, social origin, religion, age, disability, sex, marital status or pregnancy, against individuals or groups in their access to employment, services or resources
  • The elimination of poverty and the promotion of wellbeing of disadvantaged and vulnerable individuals and groups
  • A united Australia which respects this land of ours, values Aboriginal and Torres Strait Islander heritage and provides justice and equity for all.

CEO/President/equivalent Name:
CEO/President/equivalent Signature: / Date:
Send your application & supporting documents to: EMAIL:
POST: ACTCOSS Membership, 1/6 Gritten St, Weston ACT 2611

Application Process

Approval:Membership of ACTCOSS is subject to approval by the ACTCOSS Committee, which reviews membership applications once per month. ACTCOSS will notify you if we require more information for your application. Upon approval, we will send you an invoice.

Providing Payment: Please do not provide any payment until you have been notified by ACTCOSS of your membership being approved.

Fees: Fees apply for the financial year your organisation joined. If your organisation is joining between January and June, we will invoice you pro-rata for the remainder of the current financial year.Please note that fees rise by CPI every two years.

ACT Council of Social Service Inc. | 1/6 Gritten St, Weston ACT 2611 | Ph: 02 6202 7200 | |

ACTCOSS is committed to reconciliation, acknowledges the traditional custodians of the land and pays respect to elders past and present.