GRANT APPLICATION FORM 2016

MINARA COMMUNITY FOUNDATION

APPLICANT DETAILS

Organisation / Group Name
Contact Person
Job Title / Role
Postal Address
Phone / Fax / Mobile
E-Mail / Website / ABN
Is your Organisation/Group registered for GST?(Goods & Services Tax)YesNo
Do you have the following Australian Tax Office endorsements?
DGR(Deductible Gift Recipient)YesNo (please provide documentation of any endorsements)
TCC(Tax Concession Charity)YesNo (please provide documentation of any endorsements)
Organisation Description
Incorporated Association
Community Group / Charitable organisation
Special interest group / Government/localagency
Other ______
Project Name
If funding is requested for a component of a larger project or strategy, name the component for which you requirethe funding.
Project Start Date: / Project End Date: / FUNDING
Net Amount Requested$
GST$
Total Amount Requested $
Brief Project Description
State what the funding is for.
Detailed Project Description
Add more information about your project. If your project is part of a wider project or strategy, provide details here.
Project Purpose
Outline the objectives of your project (what you hope to achieve).
Ensure you identify how your project will benefit the community / build community capacity.
Project Outcomes
Detail target outcomes and how impact will bemeasured? (e.g. number of people reached,ongoing benefit to the community etc.)
Which priority focus areas does your project address?
Arts / Environment / Unemployment
Community development / Health / Youth
Culture / Preservation / Indigenous / Other; list below
Economic Development / Research
Education / Training & Development

ORGANISATION DETAILS

How long has your organisation/group been operating?
What are your organisation/group’s main activities?

PROJECT BUDGET

BUDGET ITEMS - How will you spend the funds?

Items
Net Cost $ / GST $ / Total Cost $
Grand Total / $

OTHER FUNDING OR IN-KIND SUPPORT

List here.

Supporting information, including current progress and timings, should be provided in the space below. Attach additional information where relevant, for example copy of application and grant confirmation.

Funding Body / Value $
Total In-Kind Support / $
Details of Other Funding or In-Kind Support

BUDGET CHECK

Quotations/estimates attached for any goods or services being sought. (Must add up as part of Project Budget Grand Total).

(Generally a minimum of two written quotations are required however exceptions may be made when considering remote locations. Please provide information to explain why only one quotation is provided.)

Detailed budget information attached if relevant.

Budget Grand Total and other figures in application correct.

Details of Other Funding or In-Kind Support included.

Other useful information to consider when evaluating your project application

APPLICATION CHECKLIST

I have read the Minara Community Foundation grant guidelines before completing this application.

I understand thegrant is subject to a Minara Community Foundation Grant Agreementoutlining conditions of grant, including requirements for acquittal and use of photographic images.

I have addressed the budget checklist.

I have completed all sections of the application form.

Documents included where relevant:

Copy of Certificate of Incorporation

Copy of Constitution as applicable to organisation

Copy of Deductible Gift Recipient Certificate

Copy of Tax Concession Charity endorsement

Quotations / Estimates

Other supporting documentation, letters of support etc

Support Materials

Please send copies, not originals. Materials sent in support of your application cannot be returned.

Submitting your Application

Signed and completed applications, marked to the attention of Minara Community Foundation should be submitted by 5:00pm AWST Friday 20 May 2016 as follows:

(must be a signed application)

postPO Box Z5523, St Georges Tce, Perth WA 6831

(applications accepted post-marked by closing date)

in personMinara Resources , Level 10, Alluvion Building, 58 Mounts Bay Road, Perth

DECLARATION

The person with the appropriate authority in the organisation must sign this declaration.

I have read Minara Community Foundation’s grantguidelines. I certify that all information provided is current and correct. Furthermore, I give permission to Minara Community Foundation to contact any relevant persons or organisations in the consideration and processing of this application.

Signed:
Name:
Position:
Date:

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