2017 APPLICATION FORMFRRR ABC HEYWIRE

YOUTH INNOVATION GRANTS

Please read the guidelines before completing your application. Applications close 5pm, Monday 15 May 2017. If possible, please save as a Word document & submit via email.

Enquiries can be made to FRRR on freecall 1800 170 020 or

See www.frrr.org.au for more information on applying, grantseeker FAQ’s and application top tips!

ORGANISATION INFORMATION

Organisation Name
As appears on your ABN / Inc. Certificate
Postal Address / Town / State / Postcode
Website/s / Social media addresses
Facebook / Twitter/ etc.
ABN / Incorporation Number
Don’t know? Go to www.abr.business.gov.au / You MUST attach a copy of certificate
or print out of registration
GST – Registered / Yes / No
DGR – Deductible Gift Recipient / Yes / No / Provide a copy of ATO Endorsement if applicable
TCC – Tax Concession Charity / Yes / No / Provide a copy of ATO Endorsement if applicable
Head of Organisation This person MUST sign the last page or application will not be considered. e.g. CEO, President, Chair
Mr Ms Other 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 Other Name
Position Held / Phone No
Email / Mobile

PROJECT INFORMATION

Heywire idea your community is adopting Please indicate one only
Dear CRIS / Tech Hub in the Scrub / Ag Boom / One Drop
Common Connections / Need a Nanna Network / LGBTQ&A
Grant Amount Requested
Maximum $10,000, use whole $ only / Population
Project location
Town Name
Project location / State
Project location / Post Code
Project location
Local Government Area
Project location
Proximity to nearest Capital City
Project location (e.g. 1450 Kms NE Perth, WA)
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 project involve working directly with children / youth under 18? Please indicate one only / Yes / No
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
WHO SUPPORTS THIS PROJECT? Are there project partners? Is the project community driven and can you show wider community support? List supporters and attach letters. If your application is regarding property owned by a third party a letter of consent must be attached eg: halls owned by Council
WHEN WILL THE PROJECT HAPPEN? Please outline the expected dates that this project will commence and be completed by, and highlight any project milestones. NB: You will not receive funds until end September 2017 and FRRR cannot fund retrospectively – projects should aim to be completed by end 2018.
TELL US ABOUT YOUR COMMUNITY What are the main features? What are the local resources, assets and strengths? What can you tell us about youth in your community? i.e. demographics, diversity, employment opportunities, community plans / activities / networks / organisations, events, educational opportunities, etc. IS THERE AN ISSUE, GAP OR UNIQUE REASON THAT YOUR COMMUNITY NEEDS THIS IDEA TO BE PILOTED? Detail weaknesses and issues / needs that are relevant to this proposal - describe in detail. Take the opportunity to explain why your community needs this opportunity.
WHAT DOES YOUR ORGANISATION DO? Provide a brief overview e.g. mission, founding date, programs / distinctive attributes, number of members, enrolments, staff, volunteers, engagement with other groups etc. Halls, detail use of facilities e.g. user groups, attendees, hrs. use per week / month, etc. Outline the organisational and community capacity you have to complete the project and how it will be managed. If you are already doing something similar, please let us know how it differs from the idea you wish to adopt and implement.
WHAT WILL YOU DO – DETAIL EXACTLY HOW WILL YOU IMPLEMENT THE HEYWIRE IDEA IN YOUR COMMUNITY? Please describe the project plan in as much detail as possible – you can do this in descriptive paragraphs and / or use the table template. (Try to tell us EXACTLY what steps will occur and who will make the Heywire idea come to life). WILL THERE BE YOUTH INVOLVEMENT IN THE PROJECT’S PLANNING, OUTREACH, IMPLEMENTATION AND EVALUATION? HOW WILL YOU ENGAGE WITH YOUTH? Use more space if required.
PROJECT IMPLEMENTATION PLAN (Optional template – insert more rows if required)
TASK (WHAT) / HOW / WHO / TIMELINES / RESOURCES / OUTCOME MEASURES (KPIs)
e.g. Establish youth advisory committee / Advertise opportunity on social media, in and clubs / school assembly / Community Development Officer / School welfare worker / September2017 / Communications Team
Briefing/welcome pack / Youth committee active with 10+ members
PLEASE STATE THE PROJECT’S OUTCOMES & HOW THE PROJECT WILL BENEFIT YOUR COMMUNITY? What exact OUTCOMES will be achieved? Who will benefit? How will implementing the idea make a difference to your community, and what ONGOING CHANGES do you think will result?
HOW WILL YOU MEASURE AND COMMUNICATE SUCCESS? How will you know the project is successful? How will you undertake project evaluation and / or outcomes measurement for the success described? Have you planned project outreach? Describe strategies. If possible, provide measurable numbers e.g. train 25 people, reach 60 families, 3 news stories, reach 700 likes on Facebook.
WILL THE SUCCESS OF THE HEYWIRE PROJECT BE SUSTAINED BEYOND THE GRANT? AND WHAT STRATEGY WOULD YOU HAVE IN PLACE TO ENSURE OUTCOMES ARE SUSTAINABLE LONG-TERM? Do you see opportunities for scaling the project? How would you achieve this? What’s your group’s strategy to financially sustain the project in the future?


PROJECT FINANCES

DOES THE FRRR GRANT AMOUNT REQUESTED COVER THE FULL PROJECT COST? YES NO

YOU MUST COMPLETE THE BUDGET TABLE BELOW Include all other contributions. Are these confirmed or pending? Provide quotes for costs and attach. Include a description of in-kind support in your budget, both WHO and WHAT they are contributing, e.g. discounts on quotes, waived hire, catering, project co-ordination, sponsorship etc. In-kind support is VERY highly regarded. Total income must equal total expenses.

PROJECT BUDGET (This table must be completed. Use whole $ only & insert more rows if required)
CASH INCOME / $ / CASH EXPENDITURE / $
FRRR Grant Request (as per requested $ on page 1)
Cash contribution from your organisation
IN-KIND SUPPORT - WHO
Itemise the non-cash support for the project.
Who is helping and to what value / $ / IN-KIND SUPPORT - WHAT
List & cost goods or services donated. Detail or breakdown this group / person’s support e.g. 4 hours x $25 / 10% off / $
In-kind contribution from your organisation
TOTAL INCOME / TOTAL EXPENSES
DO YOU HAVE ANY NOTES OR COMMENTS REGARDING THE PROJECT BUDGET OR IN-KIND SUPPORT? Answer optional.
2017 FRRR ABC HEYWIRE YOUTH INNOVATION GRANTS
APPLICATION CHECKLIST CERTIFICATION
ENSURE YOU HAVE COMPLETED THESE SECTIONS
and answered all questions on the form in full / ·  Organisation Information
·  Project Information
·  Project Finances / YES
YES
YES
ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material must be submitted with the application
·  Organisation Financials - either last audited statement OR current profit & loss/balance sheet (ESSENTIAL)
·  Certificate of ABN or Incorporation - or attach printout from www.abr.business.gov.au/ (ESSENTIAL)
·  Letters of support for project (OPTIONAL, but very highly regarded)
·  Quotes to support budget items (OPTIONAL, but very highly regarded)
·  Project Plan (OPTIONAL if submitting as a separate attachment)
·  Certification (see below) signed by legal head of organisation (may be submitted as a separate attachment) / YES
YES
YES NO
YES NO
YES N/A YES N/A
PLEASE COMPLETE THE BELOW CERTIFICATION - Must be signed by the legal head of your organisation or application ineligible
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.
I / We agree for FRRR and ABC to publish stories and photographs of grants funded.
HEAD OF ORGANISATION MUST SIGN HERE or application will not be considered. e.g. Chair, CEO, President NOT Secretary Treasurer etc.
(This page can be printed, signed, scanned or photographed and attached separately to the application if electronic signature unavailable)
PRINT NAME / SIGNED
POSITION / DATED
ORGANISATION NAME
PLEASE SUBMIT YOUR APPLICATION VIA EMAIL to
OR VIA POST FRRR ABC Heywire Youth Innovation Grants, PO Box 41, BENDIGO, VIC 3552.
Applications need to be clearly postmarked before or on the CLOSING DATE, 5pm Monday 15 May 2017
Note: EMAIL SUBMISSIONS & WORD DOCUMENTS ARE PREFERRED TO PDF FILES
OPTIONAL
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?
Any other comments?