Application Form
5.1 Festival and Events Fund
SECTION A : GENERAL INFORMATION
Applicants must make contact with a Screen Tasmania project officer prior to submitting applications. The allocation of project officers is subject to availability and workload.
This application form should be completed in compliance with Screen Tasmania’s 5.1 Festival and Events Guidelines, General Guidelinesand Terms of Trade. Please refer to these guidelines for the specific requirements of your application.
Please provide the name of the Screen Tasmania Project Officer with whom you have discussed your application.
Applicant Details
Applicant type / Individual Company Partnership
Other (please specify) ......
(* to check boxes, double click in the box you wish to select, this opens a dialogue box and under default value, select ‘checked’ and hit ok)
Applicant name (Contracting entity)
1. Individual / Title: / First Name: / Surname:
or 2.Company/Partnership name
Is the applicant a Tasmanian resident/Tasmanian resident production company / Yes No
Applicant/contracting entity’s ABN
Is the applicant/contracting entity registered for GST / Yes No
Postal address / Postcode
Street address / Postcode
Contact phone / Mobile
Email / Website
Contact person 1: same as applicant (if individual) / Yes No
If no, please provide the following:
Contact 1 / Title: / First Name: / Surname:
Contact phone / Mobile
Contact 2 / Title: / First Name: / Surname:
Contact phone / Mobile
Primary contact / Contact 1 Contact 2
SECTION B : EVENT SUMMARY AND HISTORY
Event title
Event synopsis (this section must be competed - maximum of 4 lines)
Event type (tick one or more)
Touring Film Festival / Single Location Film Festival / Conference
Special Event
Event History
If this event has occurred previously (with or without Screen Tasmania support) please outline the dates and locations.
SECTION B : EVENT SUMMARY AND HISTORY cont’d
Event Plan
Please provide a detailed event plan including dates, venues and event or festival content and how your event meets two or more of the assessment criteria for this fund.
Event Outcomes
Please provide details on the key measurable outcomes you are seeking to achieve through delivering your event/festival.
SECTION B : EVENT SUMMARY AND HISTORY cont’d
Who is the proposed audience for your event?
Please indicate age range, any male / female skew and any specific groups the event targets.
Proposed marketing plan
Please provide a costed and realistic marketing plan detailing how you intend to reach your targeted audience as well as well as details of any specific sponsorships benefits offered to Screen Tasmania (eg logo placement, banners, panel/speaker opportunities etc).
SECTION B : EVENT SUMMARY AND HISTORY cont’d
How does this festival or event significantly differ from others offered in Tasmania?
What are the cultural/ economic/strategic benefits to Tasmania?
SECTION C : EVENT MANAGEMENT TEAM
Please outline the backgrounds of key local management team members, recent relevant events managed by the key members of the local event’s management team. Please note, fullcurriculum vitaes of key team members should also be submitted as supporting documents (see Section F).
Team Member / Role
Team Member / Role
Team Member / Role
Team Member / Role
SECTION D : FINANCIAL INFORMATION
Estimated total event budget / $
Amount sought from Screen Tasmania / $
Has this event been considered by Screen Tasmania previously? / Yes No
If yes, please provide details
Date / Project Title / Amount requested/funded / Funded
$ / Yes No
$ / Yes No
$ / Yes No
SECTION D: FINANCIAL INFORMATION cont’d
Budget
- It is not necessary to complete all sections, only those relevant to your project and its particular stage of development
- Applicants should provide budgets exclusive of GST
- Screen Tasmania reserves the right to negotiate amendments to the budget as a condition of the provision of funds
- Screen Tasmania does not fund retrospectively.
Category / Screen Tasmania Funding / Applicant’s
contribution * / Other funding ^
Previous
$ / Requested
$ / Amount
$ / Source
$ / Amount
$
Venue Hire
Equipment hire
Film hire
Promotion / marketing
Speakers Fees
Other
Other
Other
Estimated income breakdown (other than sponsorships/grants)
Category / Screen Tasmania Funding / Applicant’s
contribution * / Other funding ^
Previous
$ / Requested
$ / Amount
$ / Source
$ / Amount
$
Ticket sales
Registration fees
Merchandise sales
Other
SECTION E : ASSESSMENT CRITERIA
Applicants are required to demonstrate that the event meets at least two of the following criteria:
it directly supports and exhibits the work of Tasmanian screen practitioners
it actively promotes digital media
it provides significant economic benefits to Tasmania
it aligns with the Tasmanian brand and enhances Tasmania’s cultural life
it has significant private financial investment or sponsorship of at least $30 000
it will provide significant nation-wide exposure of the work of Tasmania’s screen industry and Screen Tasmania
it is likely to operate independently in future years
it will be screen-based in regional Tasmanian communities without a major cinema.
Applications that meet more than two of these criteria will be looked on favourably.
Please provide further supporting information as outlined in Section F.
SECTION F : CHECKLISTPlease submit one electronic copy and two hard copies of the following:
a completed application form
an accurate and evidence based analysis of expected audience figures
a business plan including a full breakdown of all funding sources, and costs and income associated with the event
a risk analysis of the event
a summary of planned strategic growth and alternate, non-government funding sources.
details of how two of the assessment criteria listed in Section E will be met
the curriculum vitae of key personnel
Please send electronic submission to:
SECTION G : DECLARATION & SIGNATUREPublicity of Assistance
Unlike private sector financial organisations, the Department of Economic Development, Tourism and the Arts (the department) disburses public funds and is therefore accountable for the distribution of those funds. As part of the accountability process, the department may publicise the level of its financial assistance including the terms and conditions of the financial assistance as provided in the confidentiality requirements set out in the legal documentation entered into with you.
Right to Information
You should also be aware that information you provide to the department, and details of any financial assistance package, may be subject to requests for public disclosure under the Right to Information Act 2009 provided that information is not subject to the confidentiality requirements set out in the legal documentation entered into with you.
Personal Information Protection
Personal information will be collected from you for the purpose of undertaking the department’s activities. Your personal information will be used for the primary purpose for which it is collected and may be used for other purposes permitted by the Tasmanian Development Act 1983 and may be disclosed to contractors and agents of the department or affiliated bodies, and other organisations authorised to collect it.
Your basic personal information may be disclosed to other public sector bodies where necessary for the efficient storage and use of the information.
Personal information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to the department’s personal information protection officer on (03) 6233 5888. You may be charged a fee for this service.
Have you read and understood the confidentiality regulations above? / Yes NoScreen Tasmania is required to identify all relevant financial or personal interests that may exist between board members or employees of Screen Tasmania and applicants. This is to ensure that measures can be introduced to prevent a conflict of interest arising between those persons assessing the application for Screen Tasmania and such applicant. For these purposes please select the relevant statement below:
I (the applicant and my colleagues on the project) do nothave a financial and/or close personal relationship with a board member or employee of Screen Tasmania.
I (the applicant and my colleagues on the project) dohave a financial and/or close personal relationship with a board member or employee of Screen Tasmania. The nature of such relationship is:
SECTION G : DECLARATION & SIGNATURE cont’d
I/we acknowledge this submission in no way inhibits or prejudices Screen Tasmania from becoming involved in or developing other projects which may or may not have various similarities with my project.
No agreement, arrangement or obligation shall be deemed to exist between Screen Tasmania and myself/us unless and until a formal contract is made between us.
I/we are aware that in the event of this application being approved, no contracting will occur until Screen Tasmania has been provided with copies of executed documents giving the contracting party the right to exploit the material being the subject of the application either by way of assignment of copyright or an opinion.
I/we state the details provided in this application are true and correct.
Signature / Print name
Signature / Print name
Witness / Print name
Date / ……..…/……..…/……..…
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SECTION H : STATISTICAL DATAScreen Tasmania is compiling statistics on applications for its funding programs. To assist us, we appreciate the completion of the form below and return it with your application.
This information is removed prior to processing of applications and is only used to generate aggregated statistics.
Date of application / ……..…/……..…/……..…
Gender / Female Male
Country of birth
If you are a Tasmanian resident, what area of the state do you reside in?
Are you of Aboriginal or Torres Strait Islander descent? / Yes No
Do you speak a language other than English at home? / Yes No
If yes, please specify language/s spoken at home.
Do you identify as having a disability? / Yes No
If yes, please provide further details.