ORGANISATION INFORMATION

Organisation Name
As appears on your ABN / Inc. Certificate / ICSEA Value of School if applicable
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
ABN / Incorporation Number:
(Please attach a copy of certificate) / Don’t know? Go to www.abr.business.gov.au
GST – Registered / Yes ☐ / No ☐
DGR – Deductible Gift Recipient / Yes ☐ / No ☐ / (Please provide a copy of ATO Endorsement if applicable)
TCC – Tax Concession Charity / Yes ☐ / No ☐ / (Please provide a copy of ATO Endorsement if applicable)
Head of Organisation: this person MUST sign the last page or the application will not be considered
Mr ☐ Ms ☐ Name:
Position Held: / Phone No:
Email: / Mobile:
Second Contact for Application (Please provide a second contact person, with different contact details, who is familiar with the application)
Mr ☐ Ms ☐ Name:
Position Held: / Phone No:
Email: / Mobile:

PROJECT INFORMATION

Project Title
Make it catchy!
Project Aim:
(In one or two sentences)
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 YOUR PROJECT (Please indicate one only)
Culture / ☐ / Economic / ☐ / Education / ☐ / Environment / ☐ / Social Welfare / ☐ / Health / ☐
CATEGORY THAT BEST DESCRIBES THE PROJECT’S TARGET AUDIENCE
Early Childhood / ☐ / Primary School / ☐ / Secondary School / ☐
Does your project involve working directly with children/youth under 18? Please indicate one only / Yes / No
If YES, 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
DESCRIBE THE MAIN FEATURES OF YOUR COMMUNITY: such as demographics, employment, community activities, networks, clubs, organisations, economics, community & cultural diversity, festivals/events etc)
WHAT DOES YOUR ORGANISATION DO? eg: mission, founding date, major programs/activities, number of children/students, number of paid staff and/or volunteers, engagement with other community groups etc.
DESCRIBE YOUR PROJECT: List other organisations that support this project and attach supporting letters. Attach a separate page if required.
What is educational problem or need will the project address?
What evidence is there to support this?
What are you trying to achieve?
What will you actually do?
Who will be involved and what will they be doing?
What will be the direct educational benefits to the students involved?
How many students will benefit as a result of this project?
Who else will benefit from the project?
Outline the expected milestone dates of the project – you can attach a separate project plan .
HOW WILL YOU KNOW THE PROJECT HAS achieved ITS AIMS? If possible, provide measurable objectives (e.g. Our project will benefit 25 children, reach 20 families, and connect the playgroup, preschool and two primary schools through a common community based literacy program)
As a result of this project, what will occur that doesn’t occur now? What will be the outcomes? What will be the impact?
How will you measure this?
How will you share what you have learnt through this project? Who will you share it with?
HOW WILL THIS PROJECT/PROGRAM BE SUSTAINABLE AFTER THE INITIAL FUNDING HAS BEEN EXPENDED?

PROJECT FINANCES

Does the Amount Requested cover the full project cost? YES ☐ NO☐
PLEASE COMPLETE THE BUDGET TABLE BELOW: Include all other contributions. Are these confirmed or pending? Where possible, provide quotes for costs and attach. If unable to provide a quote, please state why. 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.
BUDGET
CASH INCOME / $ / CASH EXPENDITURE / $
e.g. Fundraising film night / $300 / e.g. Integrated Playground Model #5281 / $10,405
FRRR Grant Request
Cash contribution from your organisation
In-Kind Support - Who
Itemise the non-cash support for the project.
Who is helping? / In-Kind Support - What
List & cost goods or services donated or breakdown the group/person’s support e.g. 4 hours @ $25
TOTAL (must balance total expenditure) / $ / TOTAL (must balance total income) / $
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)
·  For schools, a print out from MySchool www.myschool.edu.au clearly showing ICSEA value
·  Letters of support for project (very highly regarded)
·  Quotes to support budget items (very highly regarded) if unable to provide a quote, please state why
·  Project Plan
·  Certification (see below) signed by legal head of organisation (may be submitted as a separate PDF attachment) / YES
YES
YES N/A
YES NO
YES NO
YES NO YES N/A
PLEASE COMPLETE THE CERTIFICATION BELOW - 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 funding within 12 months
I/We agree for FRRR & PA to publish stories and photographs of CATCH projects funded
HEAD OF ORGANISATION MUST SIGN HERE or application will not be considered. eg. Chair, CEO, President.
(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 before midnight Thursday 24 March 2016
EMAILED APPLICATIONS AS WORD DOCUMENTS ARE PREFERRED TO PDF FILES
OR VIA POST FRRR REAPing Rewards Program PO Box 41 BENDIGO, VIC 3552.
Applications need to be clearly postmarked before or on the CLOSING DATE, 5pm Thursday 24 March 2016