Mount Isa Mines Community Assistance Program Application Form

inara Community Foundation
Grant Guidelines and Application Form

Grant Guidelines
Minara Resources established the Minara Community Foundation in 2007 for the long-term benefit of the people in the northern Goldfields communities,where the Murrin Murrin Operations are situated.

Minara Community Foundation seeks funding applications from local groups for charitable projects and initiatives to assist communities and future generations in the northern Goldfields. Projects that provide economic, health, education and other social benefits are prioritised.

Application Form
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SUBMITTING YOUR APPLICATION

Signed and completed applications, marked to the attention of Minara Community Foundation should be submitted by Friday 28 October 2017 as follows:

Email: / Post:Minara Community Foundation
PO Box Z5523, St Georges Terrace
Perth WA 6831

Please ensure you submit the relevant information to support your application.

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

APPLICANT DETAILS

Organisation / Group Name
Contact Person / Role/Title
Postal Address / Street Address
Phone / Fax / Mobile
E-Mail / Website / ABN
Is your Organisation / Group registered for GST?(Goods & Services Tax) Yes No
Do you have the following Australian Tax Office endorsements?
DGR (Deductible Gift Recipient)Yes No (please attach documentation of any endorsements)
TCC (Tax Concession Charity)Yes No (please attach documentation of any endorsements)
Organisation Description
Incorporated Association
Community Group / Charitable organisation
Special interest group / Government/local agency
Other ______
Project Name
If funding is requested for a component of a larger project or strategy, name the component for which you require the 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 be measured. (e.g. participation numbers, completion numbers, 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 figures in application are correct and match figures on the front page.

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 the grant is subject to a Minara Community Foundation Grant Agreement outlining conditions of grant, including requirements for acquittal and use of photographic images and other media.

I have addressed the budget checklist.

I have completed all relevant 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, e.g. letters of community consultation and support

Support Materials

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

Submitting your Application

Signed and completed applications should be submitted by Friday 28 Octoberas follows:

Email:

Post: Minara Community Foundation c/ Minara Resources

PO Box Z5523, St Georges Terrace, Perth WA 6831

DECLARATION

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

I have read the Minara Community Foundationgrant guidelines. 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: / Date:
Name:
Position: