Community Sponsorship Program

Community Sponsorship Program

Application Form

Application closing date: 23rd March 2018, 5pm

Applicants are encouraged to discuss their project with the City’s Club Development Officer (Ph: 9397 3106) and read the ‘Guidelines for Applicants’ document available on the City of Gosnells website (www.gosnells.wa.gov.au) before completing this application form.

APPLICANTS DETAILS

Organisation name:
Contact person: / Position:
Postal address:
Daytime Phone: / Email:
Title of project:
To which sponsorship category does this project relate: (please check)
Minor Capital Works and Equipment
Programs and Events
Training and Support
NAIDOC Week Community Activities
Heritage Conservation Projects
What is the name of your organisation's governing body?
Does your organisation have an ABN? Yes No ABN:
Is your organisation registered for GST? Yes No
Is your organisation incorporated? Yes No
[Please attach a copy of your organisation Certificate of Incorporation]
Does your organisation have current public liability insurance? Yes No
[This is a requirement for funding. Please attach a copy of your Certificate of Currency]
If you have submitted more than one application, please rate the priority of this application against the others, with the highest priority being 1.

PROJECT DETAILS

Detailed description of project:
Planned start date for your project
Planned completion date of your project

ASSESSMENT CRITERIA

PROJECT JUSTIFICATION

What specific community need will be satisfied by this project?
How have you identified the need for this project?

COMMUNITY BENEFIT

Who and how many people will benefit from the project?

PLANNED APPROACH

What planning has been undertaken by your organisation?

MANAGEMENT PLANNING

How will your organisation manage and deliver this project?
Who owns the land on which your project will occur?

ACCESS AND OPPORTUNITY

What provisions have you made within your project to ensure access for young families, seniors and people with a disability?

COORDINATION

Have you consulted with other organisations that may be affected by your proposed project? If yes, please list the names of the organisation(s) and the part of your application they relate to:

SUSTAINABILITY

How will this project be sustained beyond the initial funding period? Are there any ongoing costs as a result of your project and how will these costs be met?
Any other supporting documentation that is relevant to this application?

BUDGET

Please indicate in the tables below your project income and project expenditure.

Project Income

Income Source / Amount $ (GST Inc)
(A) How much will your organisation contribute towards the cost of your project? eg. Cash.
(B) How much sponsorship or other in-kind support have you secured for your project?
(C) How many hours of volunteer labour are associated with your project? #
(D) Total Applicant Contribution (A) + (B) + (C)
(E) How much are you requesting from the City of Gosnells? See page 6 for a quick guide to the City's contribution levels.
(F) Total Project Cost (must equal Total Project Cost in the table below).

# Voluntary Labour is calculated at $30 per hour. Voluntary Labour may be no more than 50% of the Total Applicant Contribution

Project Cost

Cost Allocation (e.g. Advertising) / Cost $
(GST Ex) / Cost $
(GST Inc)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
(F) Total Project Cost

For significant goods or services you intend to purchase or hire (over $2,500), please attach a copy of the quote to your application.

CHECKLIST

Please check your application against the table below and ensure all relevant criteria have been completed. If any criteria have not been completed, please supply a brief comment stating the reasons.

Criteria / Yes / No / Comments If applicable
Have you discussed this project with the City’s Club Development Officer (on 9397 3106)?
For NAIDOC Week Community Activities please discuss your project with the Community Development team on 9397 3121.
Have you read the ‘Guidelines for Applicants’?
Have you enclosed a copy of your Certificate of Incorporation?
Have you enclosed a copy of your Public Liability Insurance?
Have you completed the budget and attached details as outlined in the application form?
Have you enclosed a copy of any quotes from a supplier/ service provider?
Has the application been endorsed by your organisations committee?

SPONSORSHIP AGREEMENT

If your organisation’s sponsorship application is successful, your organisation will be required to enter into a formal agreement with the City of Gosnells. This agreement will contain a comprehensive set of provisions designed to protect the interests of the applicant organisation and the City of Gosnells.

CITY SPONSORSHIP CONTRIBUTION LEVELS

The following information provides a quick guide as to the maximum sponsorship that may be sought under the various Community Sponsorship Program categories.

Category / $ Maximum / Maximum % of 'Total Project Cost'
Minor Capital Works and Equipment / 8,000 / 50
Programs and Events / 5,000 / 75
Training and Support / 1,100 / 100
NAIDOC Week Activities / 1,500 / 75
History and Heritage Conservation / 5,000 / 75

DECLARATION

I hereby certify that I have been authorised to prepare and submit this application. The information contained herein is to the best of my knowledge true and correct.

Name [Block Letters]
Signature
Position Held / Date

ALL APPLICATIONS CLOSE 5PM FRIDAY 23rd March 2018.

CONTACT DETAILS FOR OTHER SPONSORSHIP & FUNDING

Lotterywest

Ph: 9340 5270

Website: www.lotterywest.wa.gov.au

Healthway

Ph: 9321 4355

Website: www.healthway.wa.gov.au

Community Arts Network (CANWA)

Ph: 9226 2422

Website: www.canwa.com.au

ArtsWA

Ph: 9224 7310

Freecall: 1800 199 090

Website: www.artswa.wa.gov.au

Department for Communities

Ph: 6217 8700

Website: www.communities.wa.gov.au

Department of Indigenous Affairs

Ph: 9235 8000

Website: www.dia.gov.au

Department of Sport and Recreation

Ph: 9387 9700

Website: www.dsr.wa.gov.au

The Grants Referral Directory

Department of Local Government and Regional Development

Website: www.dlgrd.wa.gov.au

Grantslink

The Commonwealth Community Grants website