Regional Community Child Care Development Fund ( RCCCDF ) - Operational Grants Program

Office Use Only

Regional Community Child Care Development Fund (RCCCDF) – Operational Grants Program

Application Form

Thank you for your interest in the Regional Community Child Care Development Fund – Operational Grants Program. Before completing this form, please ensure that you:

1. Have read and understood all information in the Grants Program Guidelines.
2. Contact the senior grants officer, Department of Local Government and Communities on (08) 6551 8700 or at to discuss your project proposal and how this will meet the objectives of the program.

Section One – Applicant Details

1.1Organisation

1.2Entity type

Please tick the box which best describes your organisation:

A copy of the organisation’s Certificate of Incorporation is attached to this application:

☐Yes

☐No, the department has a copy of this document on file

☐No, this is not an incorporated agency (see 1.4 Sponsoring Organisation)

☐Not applicable, Local Government Authority or incorporated under an Act of Parliament

1.3Contact person for the project

1.4Is the organisation applying for the RCCCDF – Operational Grant an approved or licensed service?

Yes ☐No ☐

1.5Has your organisation applied for an RCCCDF - OperationalGrant in the last 12 months?

Yes ☐No ☐

1.6Please provide the following information about your organisation:

1.7Details of the contact person responsible for the daily co-ordination of the project

1.8Sponsoring organisation (if applicable)

If your organisation is incorporated, please skip this question.

If your organisation is notincorporated, an eligible organisation must apply for the grant on your behalf. The sponsoring organisation will be responsible for accepting and adhering to the conditions of the grant agreement, maintaining financial records and providing acquittal information, should your application be successful.

The sponsoring organisation’s legally authorised officer must sign the declaration of this application.

Note: The sponsoring organisation’s legally authorised officer must sign the declaration for this application under Section 5.

A copy of the sponsoring organisation’s Certificate of Incorporation is attached to this application:

☐Yes

☐No, the department has a copy of this document on file

☐Not applicable, Local Government Authority or incorporated under an Act of Parliament

1.9Taxation details of the organisation managing the grant funding

1.10Bank account details of the organisation managing the grant funding

Please indicate the preferred method of payment ☐Cheque ☐Direct Debit

Section Two – Project Details

2.1Project name ______

2.2You maytick more than one box to identify which items the grant funds will cover. Refer to pg 5 of RCCCDF Operational Grant Guidelines for item definitions.

☐Operational expenses

☐Professional development and training*

☐Information technology

☐Capital equipment

☐Governance

☐Other (please specify)

2.3Have other sources of funding been examined/applied for to partially/fully support this project?

E.g. Long Day Care Professional Development Programme, Private Enterprise, Local Governments, Local Service Groups, Lotterywest).

Yes ☐No ☐

If yes, who did you approach and what was the result?

Click here to enter text.

2.4Describe the proposed project/activities related to this application.*Please specify whether other services will be invited to participate in locally delivered Professional development and training(maximum 200 words).

Click here to enter text.

2.5If your application is for an event or conference, please provide the date(s).

Click here to enter text.

2.6Describe how the proposal will assist your education and care service to become more viable. Define how this will enhance your service to operate now and in the future (maximum 200 words).

Click here to enter text.

2.7Describe the long-term benefits the education and care service provides the community. E.g. why does your community need this service?(Maximum 200 words).

Click here to enter text.

2.8Which region will your project run in?

☐Gascoyne☐Goldfields☐Great Southern☐Kimberley

☐Mid-West☐Peel☐Pilbara☐South West☐Wheatbelt

2.9Community partnerships

What other education and care centres, groups, organisations or people are partners in this proposal?

Partners are actively involved in both the development and delivery of the project. Please list all the agencies involved, with contact details and how they will contribute.

2.10Project timeline

Please indicate the dates you expect to start and finish your project.

Note:Applications can take up to 12 weeks to process so you will need to allow approximately three months’ lead time before you start the project. Please insert actual estimated start and finish dates rather than simply stating “when the grant is approved”.

Estimated project start date:Click here to enter text.

Estimated project finish date:Click here to enter text.

Section Three – Project Budget

It is important to detail the proposed expenditure of the grant and to specify any other income that will support this project.

Use the table below to show where the money for the project is coming from and how it will be spent. Include the RCCCDF – Operational Grant in the following table and outline each budget item the grant will be allocated to. Specific information on all items must be provided, e.g. the type of training, list of equipment/IT items, staff positions, etc. Please round up all figures to the nearest dollar. Please assign a dollar value to in-kind support.

If you are getting funds from other sources to support the project, it is important you show evidence of where the money is coming from.

Section Four – Grant Conditions

Grants will be provided to successful applicants under the following terms and conditions:

1. The grant is to be used solely for the specified purpose approved by the Department of Local Government and Communities during the funding period.
2. Written approval from the Department of Local Government and Communities must be sought for any requests to vary the approved purpose or seek an extension of the funding period.
3. Any part of the grant funds that are not used in accordance with Condition 1 must be repaid to the Department of Local Government and Communities unless prior written approval is obtained.
4. Should the approved purpose of the grant cease or should the grant agreement be terminated on account of breaching the any of these Conditions, then:

(a)the balance of any grant funds, unspent on approved items, must be repaid to the Department of Local Government and Communities within ten (10) business days; and

(b)any property acquired with grant funds must be transferred to another not-for-profit organisation with similar objectives and purposes to the organisation, upon approval by the Department of Local Government and Communities.

1. Providing a grant does not mean that any further funding will be provided than that specified in the grant agreement.
2. The Department of Local Government and Communities will not be held responsible for the success of the approved purpose for which the grant is provided or for any losses or additional costs incurred that are associated with the approved purpose.
3. Any documents or information relating to the grant or the approved purpose must be provided to the Department of Local Government and Communities within ten (10) business days of the request.
4. All payment conditions and/or reporting requirements must be met, as specified by the Department of Local Government and Communities.
5. The Auditor General for the State of Western Australia, or an authorised representative, must be granted access to, and be permitted to examine, records and information concerning this grant.
6. All Local, State and Commonwealth laws applicable to the approved purpose must be abided by and complied with at all times.
7. Any project that involves working with children must ensure that the organisation and all employees and volunteers comply with the Working with Children (Criminal Record Checking) Act 2004. Please refer to the Working with Children Check website for further information
8. The Department of Local Government and Communities is not liable for any accident or negligence resulting in any claim or damage arising from activities undertaken as part of the grant.
9. Recipient organisations are required to be appropriately incorporated and be responsible for ownership of the appropriate insurance policies. This includes, but is not limited to, Public Liability, Volunteer Insurance, Workers’ Compensation, and Professional Indemnity.
10. An acknowledgement of funding assistance provided by the Department of Local Government and Communities must be included in any advertising and on any material relating to the project.
11. Any individuals involved with the project must not be exposed to significant promotions for alcohol or unhealthy food and drinks during the project.
12. Goods and Services Tax

(a)For the purposes of Conditions 17 and 18:

1. “GST” means the goods and services tax applicable to any taxable supplies, as determined by the GST Act; and
2. “GST Act” means New Tax System (Goods and Services Tax) Act 1999 (Cth) and includes all associated legislation and regulations;
3. the terms “supply”, “tax invoice”, “taxable supply”, and “value” have the same meanings as in the GST Act.

(b)If the supply of anything under the grant agreement is a taxable supply under the GST Act, the grant funds shall be inclusive of GST.

(c)If the parties agree that the Department of Local Government and Communities will issue the organisation with a Recipient Created Tax Invoice (RCTI), then the parties hereby agree that:

1. The department will issue an RCTI in respect of GST payable on the supply of the project and the organisation will not issue a tax invoice in respect of that supply;
2. The organisation warrants that it is registered for the purposes of GST and will notify the department in writing if it ceases to be registered for the purposes of GST during the term of the agreement;
3. The department warrants that it is registered for the purposes of GST and will notify the organisation in writing if it ceases to be registered for the purposes of GST, or if it ceases to satisfy the requirements of the GST Act during the term of the agreement; and
4. The department will indemnify and keep indemnified the organisation for GST and any related penalty that may arise from an understatement of the GST payable on the supply of the project for which the department issues an RCTI under the grant agreement.

1. Where applicable, the total grant funds provided by the Department of Local Government and Communities will include an amount to cover any liability for GST.
2. The Department of Local Government and Communities will issue an RCTI in respect of the grant payment, which complies with the A New Tax System (Goods and Services Tax) Act 1999 (Cth). The organisation will not be required to issue a tax invoice in respect of the grant.
3. If any of the terms or conditions are breached by the recipient organisation, the Department of Local Government and Communities has the right to terminate the grant agreement at any time and without giving prior notice.

Section Five - Declaration

This declaration is made by the applicant (an eligible incorporated organisation or local government authority) or an appropriate sponsoring organisation on behalf of the applicant:

• I declare that I am currently authorised* to sign legal documents on behalf of the organisation.
• I declare that all the information provided is true and correct.
• I give permission to the Department of Local Government and Communities, if applicable, to contact any persons or organisations in the processing of this application and understand that information may be provided to other agencies, as appropriate.
• If a grant is provided, I am aware the grant conditions as outlined in section four will apply to ensure projects are appropriately completed and accountability requirements are met.
• If a grant is provided, I agree to ensure that appropriate insurances are in place (e.g. worker’s compensation, volunteers, professional indemnity, public liability, motor vehicle, etc).
• I agree to run the project as stated, and provide a final acquittal report and statement of income and expenditure (signed by the authorised signatory) to demonstrate how the grant funds were utilised to the Department of Local Government and Communities, by the agreed date.
• I declare that the organisation is financially viable and is able to meet all accountability requirements.

Important: The application must be signed by the person legally authorised to enter into contracts on behalf of the organisation. For incorporated organisations this is generally the chairperson, president or equivalent officer. For local government authorities this is generally the Chief Executive Officer. The application may be signed by a formally authorised delegate, according to the organisation’s constitution or as bound by law.

Note: All formal correspondence will be sent directly to the legally authorised officer.

RCCDF Operational Grants Program - Application FormPage 1 of 12

Checklist

Before submitting your application for assessment, please ensure that the following steps have been completed. Please note that this checklist is included to ensure that you provide all the required information for assessment of your application.

Please tick off each step once complete and submit with your application:

Applications may be sent in the following ways:

Email:

(preferred)

Please ensure that a scanned copy of the signed Declaration page is included or a hard copy is posted within 5 business days

Post:Grants Team

Community Funding Unit

Department of Local Government and Communities

GPO R1250, PERTH WA 6844

Fax:(08) 65521555

Any application which is not lodged before the closing time will be excluded from consideration unless the applicant can provide conclusive evidence of mishandling of its application.

RCCDF Operational Grants Program - Application FormPage 1 of 12