Building Multicultural Communities Program

Application Form 2013-14

Please note: It is essential that you read the accompanying Building Multicultural Communities Program 2013-14 Application Information Booklet before you complete this form.

All questions in this form must be answered in 500 words or less.

The completed application form must be emailed to by 5pm AEST on Friday 28 June 2013. Supporting documentation in the checklist must be emailed with this form, where relevant.

If you have any questions, please contact the Department of Immigration and Citizenship on 1800 453 004 or email at .

SECTION ONE: FUNDED ORGANISATION

Section One seeks information about the organisation applying for funding, the funded organisation.

The funded organisation will be responsible for the grant funding and will enter into a Letter of Offer and/or Funding Agreement with the department, should the application be successful.

If your organisation is sponsoring another organisation, your organisation is the funded organisation. Details of the organisation you are sponsoring, the sponsored organisation, must be provided at Section Two of the application form.

  1. Full name of organisation:
  2. Trading or business name:
  3. ABN (if available):
  4. ACN (if available):
  5. Is your organisation registered with the ACNC:Yes No
  6. Previous name of organisation (if any):
  7. Organisation’s web address (if available):
  8. Is your organisation registered for GST:Yes No

Note: Organisations do not require GST registration to be eligible for funding.

  1. Date from which GST registration was effective:
  2. Is your organisation incorporated under the relevant law in your state or territory?

Yes No

Note: Unincorporated organisations are not eligible for funding. A copy of the organisation’s Certificate of Incorporation must be scanned and emailed with this form.

  1. What is the Incorporation number of your organisation:
  2. Is your organisation not-for-profit?Yes No

Note: For-profit organisations are not eligible for funding.

  1. What type of organisation are you?

Community organisationCouncil/local government

Service clubChurch association/religious organisation

Ethno-specific organisationSporting organisation

Youth organisationService delivery organisation

Other (provide details)

Details:

  1. What are the services provided by your organisation? (Example: community recreational activities, day care, social activities, physical activities, craftwork, training.)
  1. How many people use your services and/or participate in the activities provided by your organisation each month? What are their cultural backgrounds?
  1. Insurance details – type/s and amount/s:

Note: It is a mandatory requirement for funded organisations to have a public liability insurance policy in place with a minimum of $10 million cover per occurrence, covering the period up to 30 June 2014. Copies of all relevant Certificates of Currency must be scanned and emailed with this form.

  1. Address details:

Street addressPostal address

Number and street: PO Box:

Suburb:Suburb:

State/territory: State/territory:

Postcode: Postcode:

  1. Contact details:

Head of the organisationContact person

Title: Title:

Name: Name:

Position title: Position title:

Phone number: Phone number:

Mobile number: Mobile number:

Fax number: Fax number:

Email address: Email address:

Alternate contact person

Title:

Name:

Position title:

Phone number:

Mobile number:

Fax number:

Email address:

  1. What is the approximate yearly operating budget of your organisation?

For BMCP purposes, the budget only includes the costs and expenses associated with running the organisation, for example, salaries, utilities, rent, office expenses and insurance.

  1. What is the management structure of your organisation?
  1. Briefly outline your organisation’s ability to administer government funding and meet reporting requirements.
  1. Please provide details of any government funding your organisation has received previously.

Financial year / Amount (GST inclusive) / Funding source
  1. Please provide details (if any) of all identified conflicts of interest that exist or might arise in relation to your project/s.

SECTION TWO: SPONSORED ORGANISATION (IF APPLICABLE)

Section Two is only applicable to organisations being sponsored by another organisation, and seeks information about the organisation being sponsored by the funded organisation, the sponsored organisation.

The sponsored organisation will benefit from the funding, should the application be successful.

  1. Full name of organisation:
  2. Trading or business name:
  3. ABN (if available):
  4. ACN (if available):
  5. Is your organisation registered with the ACNC:Yes No
  6. Previous name of organisation (if any):
  7. Organisation’s web address (if available):
  8. What are the services provided by your organisation? (Example: community recreational activities, day care, social activities, physical activities, craftwork, training.)
  1. How many people use your services and/or participate in the activities provided by your organisation each month? What are their cultural backgrounds?
  1. Address details:

Street addressPostal address

Number and street: PO Box:

Suburb:Suburb:

State/territory: State/territory:

Postcode: Postcode:

  1. Contact details:

Head of the organisationContact person

Title:Title:

Name: Name:

Position title: Position title:

Phone number: Phone number:

Mobile number: Mobile number:

Fax number: Fax number:

Email address: Email address:

Alternate contact person

Title:

Name:

Position title:

Phone number:

Mobile number:

Fax number:

Email address:

  1. Provide a brief description of the relationship, and the consultation and agreement process between the funded and sponsored organisation in support of this application.

Note: The application on behalf of the sponsored organisation must be made with the organisation’s full knowledge and agreement, or the application may not be considered.

  1. Why are you not applying for BMCP funding in your own right?
  1. What is the approximate yearly operating budget of your organisation?

For BMCP purposes, the budget only includes the costs and expenses associated with running the organisation, for example, salaries, utilities, rent, office expenses and insurance.

SECTION THREE: GENERAL QUESTIONS

  1. How did you hear about the BMCP?
  1. Is your application for Stream One funding or Stream Two funding or both?

Note: If you are applying for Stream One funding, please complete Section Four of this form. If you are applying for Stream Two funding, please complete Section Five of this form. If you are applying for both funding streams, please complete Section Four and Five of this form.

  1. Amount of Stream One funding being sought (excluding GST):
  2. Amount of Stream Two funding being sought (excluding GST):
  3. TOTAL amount of funding being sought (excluding GST):

Note: If the total amount of funding being sought is over $20 000, you must provide a scanned copy of the funded organisation’s most recent annual audited financial statement with this form.

  1. Please provide evidence of community consultation and support.

Identify the key community organisations and individuals that are important to the success of your project/s. For example, if your project will benefit people from different cultural backgrounds, name their community leaders and their organisation(s).

Name / Position / Organisation / Consulted / Support secured
Yes No / Yes No
Yes No / Yes No
Yes No / Yes No
Yes No / Yes No
Yes No / Yes No
Yes No / Yes No
Yes No / Yes No

Note: The department reserves the right to contact the above mentioned person/s and/or organisation/s to verify their support.

SECTION FOUR: NON-FIXED INFRASTRUCTURE AND EQUIPMENT PROJECTS (STREAM ONE)

If you are applying for Stream One funding, all questions in Section Four must be answered or the application may not be considered for funding.

If the organisation submitting this application is sponsoring an organisation, the responses should be about the sponsored organisation (as per Section Two of the form), unless specified otherwise.

A: Project description and funding

  1. What is the non-fixed infrastructure and/or equipment you are applying for (brief description to support the proposed budget below)?
  1. Budget – please specify and describe each item.

Budget items (based on quotes, including GST) / Description of item / DIAC contribution (quote one) / DIAC contribution (quote two) / DIAC contribution (quote three) / Other sources (please specify)
TOTAL
  1. What is the location of your facility where the non-fixed infrastructure and/or equipment will be located?

Note: As stated in the Application Information Booklet, non-fixed infrastructure and equipment must be stored at your premises.

B: Project details

  1. How will your project enhance community development, improve community participation and help build social inclusion?
  1. What are your overall goals for the project? What will success look like?

What difference is your project going to make? What do you hope to achieve? How will your project benefit the community? Who will benefit from the project? What changes will you see in your local community as a result of your project?

  1. How will your project enhance the capacity of your organisation to deliver services and key support to your local community, and contribute to the future viability of the community?
  1. How will your project address environmental sustainability (if applicable)?
  1. How will your project continue to have an impact on the community beyond the life of the Letter of Offer?
  1. Should your application be successful:

(a)What will be the benefit to the community from your project?

(b)How will you ensure the non-fixed infrastructure and/or equipment is accessible to the community as required?

(c)How will you appropriately manage the use of and maintain the non-fixed infrastructure and/or equipment?

  1. Have you sought funding for the non-fixed infrastructure or equipment from other sources? If yes, what is the current status of that application?

SECTION FIVE: CAPITAL WORKS AND FIXED INFRASTRUCTURE PROJECTS (STREAM TWO)

If you are applying for Stream Two funding, all questions in Section Five must be answered or the application may not be considered for funding.

If the organisation submitting this application is sponsoring an organisation, the responses should be about the sponsored organisation (as per Section Two of the form), unless specified otherwise.

A: Project description and funding

  1. What is the capital works and/or fixed infrastructure you are applying for (brief description to support the proposed budget below)?
  1. Budget – please specify and describe each item.

Budget items (based on quotes, including GST) / Description of item / DIAC contribution / Other sources (please specify)
TOTAL
  1. What is the location of your facility where the capital works and/or fixed infrastructure will be located?
  1. What is the length of your tenancy?
  1. Who owns and manages the facility?
  1. Have you sought and/or secured development approval from the building owner?

Evidence of development approval must be provided with this form. If grant funding is being used for the cost of obtaining development approval, you must note that no funding will be advanced until the consent has been secured.

B: Project details

  1. How will your project enhance community development, improve community participation and help build social inclusion?
  1. What are your overall goals for the project? What will success look like?

What difference is your project going to make? What do you hope to achieve? How will your project benefit the community? Who will benefit from the project? What changes will you see in your local community as a result of your project?

  1. How will your project enhance the capacity of your organisation to deliver services and key support to your local community, and contribute to the future viability of the community?
  1. How will your project address environmental sustainability (if applicable)?
  1. How will your project continue to have an impact on the community beyond the life of the Funding Agreement?
  1. Will you be engaging contractors to carry out all or part of your project? Please provide details.
  1. Should your application be successful:

(a)What will be the benefit to the community from your project?

(b)How will you ensure the capital works and/or fixed infrastructure is accessible to the community as required?

(c)How will you appropriately manage the use of and maintain the capital works and/or fixed infrastructure?

(d)How will you ensure your project is completed by 30 June 2014?

C: Leveraged/matched funding and in-kind resources

To be eligible for Stream Two funding, organisations applying for fundingare encouraged to identify leveraged funding and/or in-kind resources for their project. Local government authorities are required, as a minimum, to provide matched funding to the grant (in the form of cash). Evidence of leveraged/matched funding and/or in-kind resources must be provided with this form.

  1. Is the leveraged/matched funding and/or in-kind resources being provided by internal or external sources (or both)? Please provide details.
  1. If you’ve sought funding from other sources, please provide details, including the current status of that application.

D: Budget

Please provide a list of all the estimated project income and costs.

Any budget items that exceed $2000 must be itemised at ‘Project budget notes’ below.

Enter funding as whole dollars rounded to the nearest $500, for example, $25 500.

Income

Total amount of grant funding sought (excluding GST)

Funded organisation’s contribution (including in-kind)

Other income/funding (further details must be provided below)

Budget itemsGrant fundingLeveraged/in-kindOther

Salaries and wages

Salaries on cost (10-15 per cent)

Contractors

Public liability insurance

Other insurance

Administrative costs

Audit (mandatory for all projects over $20 000)

Advertising/publicity

Other budget items

TOTAL

Project budget notes

  1. Please provide a breakdown of any budget items that are greater than $2000.
  1. Do any aspects of your project depend on funding from another source? If yes, what are the implications for your project if the other funding is not approved?

SECTION SIX: SUPPORTING DOCUMENTATION

Attachment checklist

A scanned copy of the funded organisation’s Certificate of Incorporation.

A scanned copy of the funded organisation’s Certificate of Public Liability Insurance.

If applicable, a scanned copy of the funded organisation’s Certificate of Professional Indemnity Insurance. (Mandatory if your project involves the delivery of professional services.)

If applicable, a scanned copy of the funded (or sponsored) organisation’s Certificate of Workers’ Compensation Insurance. (Mandatory for projects on which the funded (or sponsored) organisation’s employee/s are working.)

If applicable, a scanned copy of the funded organisation’s most recent annual audited financial statement. (Mandatory for organisation’s seeking funding of over $20 000 in total.)

For Stream One applicants:

Evidence of best value for money, i.e. copies of three quotes for the proposed purchase of non-fixed infrastructure and/or equipment.

For Stream Two applicants:

Evidence of best value for money, i.e. proof of undertaking a tender process or copies of three quotes, and if appropriate, proof of experience from similar projects.

Evidence of leveraged/matched funding and/or in-kind resources

Evidence of development approval

SECTION SEVEN: DECLARATION BY PRESIDENT OR EQUIVALENT

Declaration by funded organisation’s representative authorised to sign (please tick all boxes)

I have been duly authorised to make this application.

I have read, understood and agree to abide by the requirements of the Building Multicultural Communities Program 2013-14 Application Information Booklet.

To the best of my knowledge, there is no conflict of interest that would prevent the organisation from proceeding with the project/s or any agreement it may enter into with the department.

The information given in this application and supporting documentation is true and correct to the best of my knowledge.

The organisation will contact the department immediately if any information in this application has changed or is found to be incorrect.

Authorised by:

Position in organisation:

Date (DD/MM/YYYY):