Community Group Futures Program

Application Form: Round 5

Opens Monday,7August 2017, closes Monday, 18 September 2017

ORGANISATION INFORMATION

Organisation Name
As appears on your ABN / Inc. Certificate
Postal Address / Town / State / Postcode
Website/s / Social media addresses
Facebook / Twitter/ etc.
ABN / Incorporation Number
Don’t know? Go to / 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
Head of Organisation This person MUST sign the last page or application willnot be considered. e.g. CEO, President, Chair
Mr Ms OtherName
Position Held / Phone No.
Email / Mobile
Second Contact for ApplicationPlease provide a second contact person, with separate contact details, who is familiar with the application
Mr Ms OtherName
Position Held / Phone No.
Email / Mobile

PROJECT INFORMATION

Project Title
Make it catchy!
Project Summary / Describe the project & its main outcome/s (50 words max).
Grant Amount Requested
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 km NE Perth, WA)
Organisation Capability
Training
Paid Position / Viability & Sustainability / Cost Efficiencies for Community Infrastructure
Impact area Choose ONE only
Sustainable Economies Strong Community Social Capital Local Infrastructure Equitable Service Access
Leadership and Skills Capacity of Individuals & Organisations Quality Services for Wellbeing
Category which best describes your projectPlease indicate one only
Culture / Economic / Education / Environment / Social Welfare / Health
Category which best describes the project’s target audience Please indicate up to three only
All Community / Adults / Older People (60+) / Families / Disabled & Carers
Children & Young Adults (0-25yrs) / Early Childhood
(0-5yrs) / Children
(6-13yrs) / Youth
(13-17yrs) / Young Adults
(18-25yrs)
Indigenous Australians / CALD / Men / Women / LGBTQIA
Does this project involve working directly with children/youth under 18? Please indicate one only / Yes / No
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
TELL US ABOUT YOUR ORGANISATION
Provide a brief overview e.g. mission, founding date, programs / distinctive attributes, number of people involved i.e., enrolments, staff, volunteers, engagement with other groups etc. For halls, detail use of facilities e.g. user groups, attendees, hrs use per week/month, etc. Outline the organisational and community capacity you have to complete the project and how it will be managed.
WHAT WOULD YOU LIKE THE GRANT FOR?
Please briefly describe the activity/s for which funds are requested and please attach relevant documentation such as quotes, plans, reports etc.
NB: Purely sporting or social projects are not charitable and are not eligible.
NEED FOR PROJECT: What are the current challenges for your organisation? Why do you believe this project is the right response and how will this project help to address those challenges?
ORGANISATION OUTCOMES & IMPACT: How will the project strengthen the capacity/capability/viability of your organisation?
Consider the outcomes and how you will know you have achieved these – what will success look like and how will you know you have been successful? Please be as specific and measureable as possible; e.g. electricity costs will be reduced by 75%; programs will be more relevant and well attended resulting in improved financial performance; shared data collection between groups will result in improved responses to community needs.
COMMUNITY OUTCOMES & IMPACT: How will yourcommunity benefit?
List or briefly describe the anticipated outcomes your community will receive; e.g. more accessible services and facilities, increased opportunities for participation, more affordable options for community activities, etc)
PROJECT TIMEFRAMES: When will the project happen? (outline the expected dates that this project would become operational and completed and any key milestones. NB: You may not receive funds until post November2017 and FRRR cannot fund retrospectively.)
WHO SUPPORTS THIS PROJECT?List other organisations that are supporting this project and attach signed Letters of Support.
NB: If application is regarding property owned by a third party a letter of consent/support must be attached (e.g. halls owned by local government)
Who will be involved?What will they be doing?Are they contributing to the project with cash and/or in-kind support?

PROJECT FINANCES

DOES THE FRRR GRANT AMOUNT REQUESTED COVER THE FULL PROJECT COST? YES NO

PLEASE COMPLETETHE BUDGET TABLE BELOW FOR YOUR PROJECT

PROJECT BUDGET(use whole $ only)
CASH INCOME / $ / CASH EXPENDITURE / $
FRRR Grant Request(as per requested $ on page 1)
Cash contribution from your organisation
IN-KIND SUPPORT – WHO
(must balance in-kind expenditure) / $ / IN-KIND SUPPORT - WHAT
(must balance in-kind income) / $
In-kind contribution from your organisation
TOTAL(must balance total expenditure) / TOTAL(must balance total income)

If you are unsure about how to complete this budget, please ring 1800 170 020 to discuss.

TELL US ABOUT YOUR ORGANISATION’S FINANCIAL CAPACITY

Has your organisation previously received and acquitted a grant before? / Yes / No
What was your total annual turn-over last financial year?Round to the closest whole dollar / $
ATTACH ONE OF: Indicate ONE only
Audited statements for the last financial year?
Profit and Loss Statement AND Balance Sheet for the last complete financial year? / Yes Attached
Yes Attached
IF THESE SHOW: Answer ONE only
PROFIT/ SURPLUS/LARGE CASH RESERVES
  • Is your surplus/cash reserves held for a project?
  • Are you fundraising for any other major projects?

OR
LOSS/ DEFICIT
  • What is the reason why you have a loss / deficit?
  • Do you foresee this changing?

APPLICATION CHECKLIST & CERTIFICATION
ENSURE YOU HAVE COMPLETED THESE SECTIONS
and answered all questions on the form in full /
  • Organisation Information
  • Project Information
  • Project Finances
  • Organisation Finances
/ YES
YES
YES
YES
ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material must be submitted with the application
  • OrganisationFinancials - either last audited statement OR current Profit & Loss/ Balance Sheet (ESSENTIAL)
  • Certificate of ABN or Incorporation - or attach printout from (ESSENTIAL)
  • Letters of Support for project (very highly regarded)
  • Quotes to support budget items (very highly regarded)
  • Project Plan (very highly regarded)
  • Certification (see below) signed by legal head of organisation (ESSENTIAL - may be submitted as a PDF attachment)
/ YES
YES
YES
YES
YES
YES
PLEASE COMPLETE THE BELOW CERTIFICATION - Must be signed by the Head of the Organisation or cannot be considered for funding
  • 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 FRRR funding within 12 months.
  • I / We agree for FRRR to publish stories and photographs of grants funded.

HEAD OF ORGANISATIONMUST SIGN HERE or application will not be considered. e.g. Chair, President, CEO(NOT Secretary, Treasurer etc.)
NAME: / SIGNED:
POSITION: / DATED:
ORGANISATION NAME:
PLEASE SUBMIT YOUR APPLICATION, VIA EMAIL
or VIA POST,FRRR, PO Box 41, BENDIGO, VIC 3552.
Applications need to be clearly postmarked before or on theCLOSING DATE, 5pm Monday 18th September, 2017
Note: EMAIL WORD DOCUMENTS ARE PREFERRED TO PDF FILES
Optional questions and
feedback on application process / On a scale of 1= Easy to 5= Hard, how would you rate this application?
Please estimate time taken to complete application in hours?

Community Group Futures 20171