FUNDING APPLICATION FORM
So that your application can be given full consideration, please address each section and question as numbered on the following Funding Application Format.
(The application is in Microsoft Word so you can type directly into the document under each heading.)
APPLICATION CHECKLIST:
your application is signed by your organisation’s Authorised Officer
you have answered each question in accordance with the attached format
proof of your Deductible Gift Recipient (DGR) status has been provided
any quotes, budgets or other supporting documents have been provided
your most recent Annual Report / audited financial statements are provided
Postto: The Executive Officer
Coopers Brewery Foundation Inc Trust
PO Box 46
REGENCY PARK SA 5942
Or deliver to:Coopers Brewery Reception at
461 South Road, RegencyPark
Emailed applications will not be accepted.
Coopers Brewery Foundation Incorporated Trust
ABN 27 527 326 152
FUNDING APPLICATION FORMAT
Section 1General Information
1.1 Name of organisation
1.2 Australian Business Number (ABN)
1.3 Postal Address
1.4 Contact name of person lodging application
1.5 Position within organisation of contact person
1.6 Direct phone number or mobile number
1.7 Fax number
1.8 Email address (to receive confirmation of application lodgement)
1.9 Website address
1.10 Bank account number for direct credit of funds if your application is successful (optional)
Section 2Organisation information
2.1 When your organisation was established and brief history
2.2 Description of aims and objectives including mission statement
2.3 Briefly describe what major services your organisation provides
2.4 The number of volunteers in your organisation
2.5 How is your organisation funded? Please provide approximate percentages of each activity. eg Local, State or Federal Government, donations, members, service/sales provision, fundraising activities etc.
Section 3Project Details
3.1 Outline the ‘project’ for which you seek funding from the Coopers Brewery Foundation?
3.2 What is the amount of monetary assistance (excluding GST) you are requesting from Coopers Brewery Foundation?
3.3 Please describe the project:
the expected time frame (start, finish or ongoing)
short term benefits
long term benefits
how it fits with the Foundation’s philosophy and assessment criteria.
3.4 Provide a budget outlining costs involved with the project (including staff salary costs)
3.5 What proportion of your Project cost are you seeking from the Coopers Brewery Foundation?
3.6 How many people are likely to benefit from this funding?
3.7 Please specify the primary age group of the beneficiaries
3.8 Will the funding be directed primarily in Metropolitan or Regional Australia?
3.9 Please advise any recognition opportunities that you could provide the Coopers Foundation if your application is successful
3.10 Do you have a specific Trust account for this project?
3.11 Have you engaged Fundraising consultants to raise money for this project?
If so, please state their company and contact details.
Section 4Previous Funding
4.1 List any previous funding received from Coopers Brewery in the past 5 years.
If you are unsure, please contact the Foundation Office.
Section 5Declaration
(Please include the following statement at the end of your application and have it signed by your Executive Officer/President/Chairman).
“I have noted the information contained in the Foundation’s Guidelines and understand that applications are considered and determined by the Governors’ of the Coopers Brewery Foundation Inc Trust and that their decision is final.”
Signature ………………………………………
Name ………………………………………
Title………………………………………
Date ………./…………../…………….
Page 1 of 3