Community Sponsorship Program
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 DETAILSOrganisation name:
Contact person: / Position:
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.
Detailed description of project:
Planned start date for your project
Planned completion date of your project
PROJECT JUSTIFICATIONWhat specific community need will be satisfied by this project?
How have you identified the need for this project?
COMMUNITY BENEFITWho and how many people will benefit from the project?
PLANNED APPROACHWhat planning has been undertaken by your organisation?
MANAGEMENT PLANNINGHow will your organisation manage and deliver this project?
Who owns the land on which your project will occur?
ACCESS AND OPPORTUNITYWhat provisions have you made within your project to ensure access for young families, seniors and people with a disability?
COORDINATIONHave 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:
SUSTAINABILITYHow 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?
Please indicate in the tables below your project income and project expenditure.
Project IncomeIncome 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 CostCost Allocation (e.g. Advertising) / Cost $
(GST Ex) / Cost $
(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.
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?
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
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]
Position Held / Date
ALL APPLICATIONS CLOSE 5PM FRIDAY 23rd March 2018.
CONTACT DETAILS FOR OTHER SPONSORSHIP & FUNDING
Ph: 9340 5270
Ph: 9321 4355
Community Arts Network (CANWA)
Ph: 9226 2422
Ph: 9224 7310
Freecall: 1800 199 090
Department for Communities
Ph: 6217 8700
Department of Indigenous Affairs
Ph: 9235 8000
Department of Sport and Recreation
Ph: 9387 9700
The Grants Referral Directory
Department of Local Government and Regional Development
The Commonwealth Community Grants website