application form | 2015
category A: Innovate
category B: Create
Community Arts Network WA manages this fund on
behalf of the State of Western Australia through
the Department of Culture and the Arts and
is supported by the Mental Health Commission WA.
COMPLETING THIS FORM
This is an application form for category A: Innovate ANDcategory B: Create. For categories C and D please visit our website or contact CAN WA.
Please print in BLOCK letters. Incomplete or illegible forms will not be accepted.
Before you complete this form have you:
Contacted CAN WA to discuss your project? YESNO
Submitted a DRAFT application AND budget for review by CAN WA? YESNO
Considered and addressed any copyright issues relating to your project? YES NO
APPLICANT’S DETAILS
The applicant for funding is an:
Individual – If so, are you a citizen or permanent resident? CITIZENP/R
Organisation
Group
(Note: groups or individuals without an ABN must be auspiced by an incorporated body)
Applicant’s name (or group/organisation):
Project contact person:
Postal address:
Postcode: Telephone: Facsimile:
Email:
Do you have an Australian Business Number (ABN)?YESNO
Yes, my ABN is:
If No, do you have a certificate of exemption? YESNO
AUSPICING BODY(contact CAN WA for assistance with auspicing)
Do you have an auspicing body? YESNO
Auspicing body’s name:
Auspicing body’s contact person:
Postal address:
Postcode: Telephone: Facsimile:
Email:
Auspicing body’s ABN:
PROJECT DETAILS
Project title:
Project starting date: Project ending date:
PROJECT COST
Total cost of project (excluding GST): $
Amount requested from CATALYST (excluding GST): $
ADDITIONAL INFORMATION
PUBLIC LIABILITY
As part of implementing a risk management approach to organisational activities, organisations are reminded of the benefits of obtaining public liability insurance cover for such activities.
Is the applicant/organisation covered by public liability? YESNO
If No, please state why:
If Yes, what level of public liability cover? $
REFEREES
Please list the details of the two (2) referees below. Referees are expected to be people who can vouch for you/or your organisation/group skills, experience and reliability.
Referee 1. Name:
Address:
Contact number:
Referee 2. Name:
Address:
Contact number:
BUDGET
You must fill out the Catalyst Budget form and hand this in with your application. Budget forms can be downloaded from CAN WA’s website ( request a form or call (08) 9226 2422.
Catalyst Budget form attached
SUPPORT MATERIAL
You must include the following essential support material with your Catalyst application:
(For further information about support material refer to the Catalyst Funding Guidelines)
Essential Support Material:
Letters of support: from individuals / organisations / communities. Please state the number of letters and list them here in the order they appear.
For Example:
- City of Perth
- Perth YMCA
- Etcetera
Agreement letters/emails: from key coordinators / artists. Please state the number of letters/emails and list them here in the order they appear.
CV / resumes: from Project Coordinator and key art workers / artists (max two pages per worker).Please state the number of CVs/resumes and list them here in the order they appear.
Fee quotes: from key coordinators / artists. Please state the number of artist/coordinator quotes and list them here in the order they appear.
General quotes (for single cost items in the budget over $1000)
Please state the number of quotes and list them here in the order they appear.
Other support material may include:
Certificate of incorporation(if applicable)
Photos (up to 10 jpg photos on disc or printed)
DVDs / visual media (5 minutes of visual material)
Reports / reviews (up to 5 pages of reports, media clippings or related promotional material) Details:
DECLARATION
Please sign and date the form below.
I have read the guidelines relating to this program and certify to the best of my knowledge, the information provided in these forms and attached sheets is correct.
The applicant is NOT currently in receipt of multi-year funding from the Department of Culture and the Arts WA OR Mental Health Commission WA and does NOT have an outstanding acquittal for funds received from Country Arts WA, Healthway, Department of Culture and the Arts WA and the Mental Health Commission WA.
Applicant:(if the applicant is an organisation or association, the declaration must be signed by the CEO, Chairperson or President).
Signature:
Name:
Date:
Auspicing body:
Signature:
Name:
Date:
SEND YOUR APPLICATION TO:
Funding Manager, Community Arts Network WA, PO Box 7514, Cloisters Square, Perth WA 6850.
Further information, call CAN WA on 9226 2422, (country callers) 1800 681 021.
Applications must be postmarked by 5pm on the closing date
Application Questions
CATALYST FUNDING CRITERIA:
The Catalyst Community Arts Fund supports projects that:
- Facilitate and support Western Australian community-determined arts and culture activities that express local culture and identity
- Promote the values of community empowerment, social inclusion, respect for diversity and self-determination.
CATALYST FUNDING CATEGORY:
This application form is for projects that will be funded in either Categories A or B:
Category A Innovate – innovative community arts projects that express local culture and identity
OR
Category B Create-community arts projects that express local culture and identity.
If the Catalyst Funding Panel considers your project to be innovative, they can choose to fund your project within the Innovate category. Innovate isfor projects that are deemed by the panel to be developing new and innovative community arts practices,or bringing new ways of working or new art forms to community arts practice.
The Innovate category is a way of recognising innovation in community arts projects. Please note, all applications will be assessed on how they meet the Catalyst funding criteria, with no preference for categories A or B.
Applicants must address the following questions to be eligible for funding:
- What are you planning to do?
Describe the project in full and detail how the project fits the Catalyst funding criteria. Include an opening sentence that summarises the project and what the Catalyst funds will be used for. If you consider your project to be innovative, please explain why in this question.
(Response should be no more than 500 words).
- Why are you doing this project?
What is the purpose, what are the objectives and how are they linked to the Catalyst funding criteria?
(Response should be no more than 500 words).
- Who is involved in your project?
(a)Who is or who are the communities that are participating in the project?
Provide an overview of the participating community, including information such as age range, ethnicity, geography and cultural background. Letters of support from participants and participating groups or communities should be included as part of your support material.
(Response should be no more than 250 words).
(b)Who will coordinate the project and who will provide the artistic and cultural development expertise?Provide a list of the professionals involved in the project, stating their name and role in the project. Provide a brief overview of their skills and expertise and include their CV’s, letter/email of agreement and quote for fees as part of your support material.
(Response should be no more than 200 words).
- Where is your project taking place?
(Response should be no more than 100 words).
- When will the project begin and end?
Include a schedule and list of project activities.
(Response should be no more than 300 words).
- How will this project happen?
Detail the steps and describe the processes. How will you gather participants? How will the project be promoted?
(Response should be no more than 300 words).
- How will you document this project?
How do you propose to record the progress and/or outcomes of your project?
Documentation of your project might include photos, video and sound recordings, publications, media clippings, copies of notes and correspondence, artist and participant journals and blogs. This is likely to be useful in future applications and in promoting your practice.
(Response should be no more than 150 words).
8. How do you plan to evaluate your project?
Evaluation of a project can be either a subjective or objective appraisal of the success or failure in relation to the project goals. You need to explain how you will determine whether you have achieved your objectives.
(Response should be no more than 150 words).
Examples of objective appraisal include:
- Participant and audience numbers, analysis of website traffic and the amount of work produced.
Examples of subjective appraisal include:
- Written self-assessment, peer assessments, feedback from your audience, project participants and other interested parties.
9.What do you think would be the anticipated impacts of this project, both short and long term? (Response should be no more than 300 words and separated into short and long term impacts.)