Disability Awareness Week 2017

Thank you for your interest in the Disability Awareness Week grants. Before completing and submitting this form please ensure you have read and understood the information in the Grant Guidelines available at > About us > Disability Awareness Week.

Enquiries: Phone 9426 9622or email

Grant application form

Applicant details

Organisation and contact details

Organisation name:
Contact person and position title:
Phone:
Email:
Postal address:

Auspicing organisation (if applicable)

If your organisation or community group is not incorporated, the grant must be applied for on your behalf by a not-for-profit incorporated organisation or a local government. The auspicing organisation will be responsible for accepting and adhering to the conditions of the grant, maintaining financial records and providing acquittal information, should your application be successful.The auspicing organisation’s legally authorised officer must sign the Authorisation section at this end of this form.

Organisation name:
Contact person and position title:
Phone:
Email:
Postal address:

Event details

Event name:
Date/s and time/s:
Venue and location:

Briefly describe your event

How will this event celebrate people with disabilities and raise awareness of the importance of welcoming, accessible and inclusive communities? (please address the eligibility criteria)

How will you use the grant money?

Item / Cost (approximate)
TOTAL COST

Grant terms and conditions

On behalf of the organisation, please tick ‘yes’ to agree or ‘no’ to disagree tothe terms andconditions outlinedbelow. / Yes / No
The event venue is accessible to people of all abilities. / ☐ / ☐ /
We give permission for the event information to be published on Communities digital channels, including its websites, social media platforms and
e-newsletters, and via Disability Services and ministerial media releases. / ☐ / ☐ /
Wewill supply high-resolution photos of the event with signed consent forms of participants for use in a range of Communities digital and print publications. / ☐ / ☐ /
Our organisation/group has appropriate insurances (public liability etc.). / ☐ / ☐ /
If required we will provide Communities the information or evidence needed to prove how the grant criteria and terms and conditions were met. / ☐ / ☐ /
Wewillreturn the grant money in full to Communities if the event does not take place. / ☐ / ☐ /

Authorisation

To be completed by the Chief Executive Officer or authorised delegate:

Signature:
Print full name and position:
Date:

Submitting your application

Disability Awareness Week grant applications close at 5.00pm on Wednesday1 November 2017 and can be submitted the following ways.

Email to:

or

Post to:Disability Awareness Week Grants
Sector Engagement & DevelopmentBranch

Department of Communities, Disability Services

PO Box 441

West Perth WA 6872

Please note:applications postmarked prior to, or on the closing date, but received after that date, will not be accepted. We encourage you to email your application to ensure it arrives by the closing time and date.