COMMUNITY FUNDING PROGRAM

2018 FundingApplication Form

Tell us who will be in charge of this project

First name
Last name
Position within your organisation
Postal address
Street address
The best telephone number to be reached on
The best email address to be reached on
Give us the details of the NHW Group leading this project
Official name of the NHW Group
Official contact person's name
Does the NHW Group have an ABN? if so, please list
Are you incorporated?
What is your Incorporation Number?
What is the postal address for the NHW Group?
Official contact person's telephone number
Official contact person's email address
Are you registered for GST?
We encourage you to work with your Local Governmentorganisation.
Can you give us some details of the person assisting your project
What is the official name of your local Government organisation? i.e. Shire name
What is the name and position of the local government contact?
What is the local government postal address?
Local government contact email
Local government contact telephone number
Tell us briefly what your contact and their organisation will be doing to assist you with your project
Police participation – if applicable
(approval must be obtained from District or Regional Commander)
Name and rank
Position
Station/District
Date
Name and rank
of approving officer
Tell us about the Neighbourhood Watch Group leading this project.
When it was established, the number of members, how often you meet and your preferred form of communication within your group.

Tell us about your Project

Project Name:
1. / Short Project Description: Please give us a brief summary of your project in no more than 75 words. This description will be used in a range of reports.
2. / Why is this project needed? Describe the crime issues you are seeking to address and its impact. Refer to local information and evidence. If applicable, please provide evidence to support your answers.
3. / Who is the target group for the project? –Describe the community members who will be affected by this project. Are they NHW members, young, seniors, or do theycome from culturally and linguistically diverse backgrounds?
4. / Why do you think your project will be effective in responding to the crime prevention issues identified in Question 1?
5. / If your application is successful, who will benefit from this project?

Project Outline

Outline the tasks necessary to undertake the project. / Provide the expected commencement date and completion date for each task. / Outline how you will demonstrate that each task outcome has been achieved?

Expenditure-items to be purchased with the Community Funding

Description of items / Total cost
$ / In-kind or other contribution (ifapplicable) / Funds Requested
$
TOTAL FUNDS REQUESTED / $

Obtain estimates/quotes for costs involved with your project keeping in mind the maximum amount available is $3,000. Please attach them to your application.

Payment Details

The following details must be provided with your application.

Account Name / BSB / Account Number / ABN if applicable / Registered for GST Y/N

Community Funding Program

Please indicate how you heard about the Community Grant Scheme. This will assist in relation to future community funding programs:

  • Newspaper
  • Online
  • Facebook
  • Word of mouth
  • Other (please specify): ______

Agreement

I have read and agree to the terms and conditions outlined below

Applicant Declaration

I, (full name) …………………………………………………………………………………………………………………………………,

declare that this application form has been completed accurately and I am authorised to lodge this application on behalf of this group or organisation;

If this application is successful, this organisation will abide by the conditions of the funding.

The applicant agrees to be responsible for maintaining adequate insurance coverage for the period of the funding.

Applicant Name:
Organisation:
Signed (postal applications only):
Date:

Lodgement

Please allow sufficient time when submitting applications as late applications may not be accepted.Applications close at 5pm on Friday 16thFebruary 2018. Once you have completed your application, please email it to:

Although an electronic copy is preferred, if you are sending a hard copy application, please post the signed original application to:

CommunityFundingProgram

Neighbourhood Watch Australasia

PO Box 64

Spring Hill QLD 4004

Once your application is lodged, you will receive a confirmation email.

NHWA Community Funding Program – TermsandConditions

The terms and conditionsof this funding program are as follows:

1. All applicants must be:

  • From a member jurisdiction of Neighbourhood Watch Australasia
  • An incorporated not-for-profit organisation, OR
  • An organisation sponsoring an unincorporated not-for-profit organisation, OR
  • A local government council working in partnership with Neighbourhood Watch, OR
  • Members of an Australian Police Force or Service working in partnership with the community.

2. Neighbourhood Watch Australasia Inc. (‘Funding Administrator’) will provide the successful applicant(s) (‘Fund Recipient’) with a one-off fund payment of the amount determined by the Fund Administrator in its sole and absolute discretion.

3. Recipients of funding must enter into and comply with a Funding Agreement accepting the fund payment in accordance with these guidelines. Once complete, the FundingAgreement is a legal contract between the Funding Administrator and the FundRecipient and sets out the obligations of each party.

4. Funding granted must be used and applied solely for the purpose of the project stated in the application and as approved by the Funding Administrator.

5. Should the actual total project costs be more than the proposed project costs, the Funding Administrator will not be responsible or obligated to pay any monies additional to the notified grant amount.

6. The term of the fundingproject is one month or less.

7. Expenditure of the funding must be completed within the one month period noted in the Funding Agreement.

8. All financial and operational reporting requirements must be completed within the specified timeframe. This includes, but is not limited to, completing and lodging a final project report and financial acquittal.

9. In the event of cancellation of a funded activity, the Fund Recipient must notify the Funding Administrator in writing. A change of purpose may be applied for or the unspent money returned immediately.

10. A grant may be terminated and the money must be returned immediately if, in the opinion of the Funding Administrator, any of the following apply:

•The project is not being carried out to the satisfaction of the FundingAdministrator

•The terms and conditions of the Funding Agreement are breached

•Any special conditions attached to the funding are breached, and/or

•The Fund Recipient fails to provide information concerning administrative or financial aspects of the project in response to a reasonable request.

11. All promotional material must acknowledge funding from the AustralianGovernment and the Funding Administrator. Requests to use the Funding logo/s must be submitted to and approved by the FundingAdministrator prior to production and release.

12. If applicable - the Fund Recipient will take out and maintain adequate insurance (including public liability insurance) for the activities carried out by the Fund Recipient in relation to the project.

13. The Fund Recipient must remain the Fund Recipient of the funded project for the duration of the Funding Agreement or until a new Fund Recipient is approved.

14. The Funding Administrator has the opportunity to promote and report on the Project to its partners, staff, customers and the community through internal and external communication channels including the media.

15. NHWA project grants are subject to the Goods and Services Tax (GST). Where an organisation funded by NHWA is liable to pay GST, the amount payable by NHWA, will be increased by the amount of the GST liability, and provided that the organisation:

• Is registered for GST

• Has an Australian Business Number (ABN), and

• Provides NHWA with a valid Tax Invoice

16. All successful applicants may be subject to a random audit process.

17. The committee may consult with the sponsoring organisation, local government authority or relevant police regarding your application.

Page 1 of 72018 CFP Grant Application Form