Community Grants Program

Report Form

Major Programs (up to $50,000)

Grantee organisation details

Organisation’s legal name / [Click here to enter the organisation’s legal name]
Street address / [Click here to enter street address]
Suburb / [Enter suburb] / Postcode / [Enter postcode]
Postal address / Please tick if same as above ☐
[Click here to enter postal address]
Suburb / [Enter suburb] / Postcode / [Enter postcode]

Contact person (Project contact)

Title / Mr ☐ / Mrs ☐ / Ms ☐ / Dr ☐
Name / [Click here to enter contact name]
Position / [Click here to enter contact position]
Telephone / Business: / [Enter phone] / Mobile: / [Enter mobile]
Email address / [Click here to enter email address]

Organisation contact (CEO, Chair, President)

Title / Mr ☐ / Mrs ☐ / Ms ☐ / Dr☐
Name / [Click here to enter organisation contact name]
Position/role / [Click here to enter organisation contact position]
Telephone / Business / [Enter phone] / Mobile / [Enter mobile]
Email address / [Click here to enter email address]

Program summary

Program title / [Enter program title]
Program location / [Enter program location]
Program dates / Start: [Enter date] / End: [Enter date]
What was the total cost of the program? (GST exclusive) / [Enter total cost of the program]
What was the CGP grant amount? (GST exclusive) / [Enter the CGP grant amount]

Program details

Provide a brief outline of the program that was delivered:
[Outline the program that was delivered] /

Grant criteria and strategic focus areas

Please select the grant criteria that applied to your program from one or more of the following:

  • it strengthens the capacity of culturally diverse communities ☐
  • it supports the development of culturally inclusive policies, programs
    and services☐
  • it facilitates full participation by culturally diverse communities in social,
    economic, cultural and civic activities☐
  • it develops intercultural understanding and promotes the benefits of Western Australia’s cultural diversity ☐

How did your program address your selected grant criteria?
[Enter how your program addressed your selected grant criteria] /
Provide an overview of the partner organisations and partnership arrangements for your program including the name of each partner organisation, their role/contribution to the program and/or the activities that they delivered.
[Outline the partner organisations and partnership arrangements for your program] /

Program reach

Actual number of participants/audience/spectators
Age group / Male participants / Female participants / Audience/spectators
Children 12 years and under / [Enter number] / [Enter number] / [Enter number] /
Youth 13–17 years / [Enter number] / [Enter number] / [Enter number] /
Adults 18–61 / [Enter number] / [Enter number] / [Enter number] /
Seniors 62 and over / [Enter number] / [Enter number] / [Enter number] /
Total: / [Enter number] / [Enter number] / [Enter number] /
Actual number of personnel/partnerships
Who / Number / Roles
How many paid staff? / [Enter number] / [Enter role] /
How many volunteers? / [Enter number] / [Enter role] /
How many partner organisations?
(you must name all partner organisations and their role) / [Enter number] / [Enter role] /
How many participant organisations? / [Enter number] / [Enter role] /
Type of key activities or events
Activity type / Venue / When
[Enter activity type] / [Enter venue] / [Click here to enter text] /
[Enter activity type] / [Enter venue] / [Click here to enter text] /
[Enter activity type] / [Enter venue] / [Click here to enter text] /
[Enter activity type] / [Enter venue] / [Click here to enter text] /
[Enter activity type] / [Enter venue] / [Click here to enter text] /
Promotional and media coverage
Coverage / Yes/No / Detail—for example: 1 x media release, 1 x advert in AB newspaper, etc
Newspaper / [Enter Y/N] / [Enter detail] /
Advertisements / [Enter Y/N] / [Enter detail] /
Flyers / [Enter Y/N] / [Enter detail] /
Radio / [Enter Y/N] / [Enter detail] /
Social media / [Enter Y/N] / [Enter detail] /
OMI website / [Enter Y/N] / [Enter detail] /
OMI signage / [Enter Y/N] / [Enter detail] /

Program evaluation

In 300 words or less, report on how the program met the success measures (key performance indicators) outlined in the grant agreement:
[Report on the program success measures] /
In 150 words or less, provide an overview of the lessons learned in delivering the program – what worked well and what could have been improved?
[Enter the lessons learned – what worked well and what could be improved]
In 150 words or less, provide an overview of your future planning and opportunities following this program:
[Enter your future planning and opportunities following this program]

Certified Financial Statement

Please complete the following tables and attach additional information if required.

Income / Amount ($)
CGP amount / [Enter amount] /
Other income sources(including funding organisation) / Amount ($)
[Enter income source] / [Enter amount] /
[Enter income source] / [Enter amount] /
[Enter income source] / [Enter amount] /
In-kind contributions / Amount ($)
[Enter in-kind contribution] / [Enter amount] /
[Enter in-kind contribution] / [Enter amount] /
[Enter in-kind contribution] / [Enter amount] /
TOTAL / [Enter amount] /
Expenditure items / Amount ($) / Funding organisation
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
[Enter expenditure item] / [Enter amount] / [Enter funding organisation] /
TOTAL / [Enter amount] /

DECLARATION

I certify that the information provided is to the best of my knowledge, true and correct.

I, the undersigned, hereby certify that the funds have been used for the purposes for which they were granted by the Office of Multicultural Interests.

Name:[Enter Name]

Position:[Enter Position]

Organisation:[Enter organisation]

Date:[Enter todays date]

When you have completed this form please print it and sign in the box below.

Signature:

Project Report Checklist

Ensure these actions have been completed and attach the relevant documents before the project report is submitted.

  1. Certified financial statement is signed by an authorised office bearer ☐
  2. Copies of promotional materials and any photos taken for reporting purposes only ☐
  3. Media statement and newspaper clippings ☐
  4. Photos (with appropriate photo permissions) that may be placed on OMI's website for promotional purposes ☐
  5. Retained a copy of the signed project report ☐

Project Report Submission

Reports can be submitted by:

Email
Send your report and supporting materials to:

Grants Officer

Post
Send your report and supporting materials to:

Grants Officer
Office of Multicultural Interests
GPO Box R1250
PERTH WA 6844

Delivered
Enclose your report and supporting materials in an envelope and deliver to:

Grants Officer
Office of Multicultural Interests
Level 2, Gordon Stephenson House
140 William Street
PERTH WA 6000

Contact Information

Grants Officer
Office of Multicultural Interests
Phone: (08) 6552 1619
Email:

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