Cancer Council Australia

Shade for Secondary Schools Program Application Form

Thank you for participating in the Shade for Secondary Schools Grant Program.This form must be completed in full including adding your attachments to your email.

This Application Form is separated into six sections including:

(Part A) – Personal Information

(Part B) – Grant Terms and Conditions

(Part C) – Shade Item and Justification

(Part D) – Your Budget

(Part E) – Payment

(Part F) – Approvals

You must fill in all mandatory sections marked with an asterisks (*) and please be sure to prepare all your documents prior to filling in this form. See our Frequently Asked Questions section for the documents that you need to prepare and attach to your application.

Please allow up to 45 minutes to complete the application, assuming you are eligible and have the required documentation ready.

Part A - Personal Information

Date of Application*

Organisation/School Name*

Director, Principal or Manager of organisation*

Applicant's Full Name*

Applicant's Position*

Applicant's contact phone number(office or mobile phone number, please include area code)*

Applicant's Email*

Organisation's Address

Street Address Line 1*

Street Address Line 2*

Suburb/Town*

State or Territory*

Where did you initially hear about the Shade for Secondary Schools Grant Program?*

Cancer Council Australia website

Direct contact from state SunSmart / Cancer Council

eftpos or eftpos Giveback website

Radio

Print media

Social media – Facebook, Twitter

Cancer Council Helpline

Word of Mouth

Local Newsletter

Other

If Other, please specify where you heard about the Shade for Secondary Schools Grant Program.

Privacy collection statement

Privacy Statement: By providing us with personal information, you consent to its collection and use in accordance with our Privacy Collection Notice.*

Yes I agree

Part B - Grant Terms and Conditions

Please read and agree to our terms and conditions*

Yes I agree

Part C - Shade Item and Justification

1. Shade item requested

Grant funds must be spent on the agreed item as chosen in Part C and approved by the judging panel. The grant amount is GST inclusive and any GST implications become the responsibility of the funded organisation. Please choose from one of the four options from the list below.

Portable shade structure – marquee kit

Permanent shade structure – shade cloth

Permanent or portable shade with natural shade

Natural shade eg trees or plants

Please note: All schools should make their own informed decision when it comes to choosing a design and style that suits their needs and a reputable supplier to deliver and erect their new shade. Cancer Council Australia does however endorse the shade marquees by Star Outdoor.

2. Aim of Funding Request

Briefly outline why your organisation needs the Shade for Secondary Schools Grant Program to fund the shade item. * (maximum of 500 characters)

3. How will your organisation look after and maintain the shade item to ensure it benefits the students in your care for a long time? * (maximum of 500 characters)

4. Successful skin cancer prevention requires a multi-strategy approach. What other SunSmart initiatives have been implemented within your organisation to reduce sun exposure? * (maximum of 500 characters)

Have you uploaded the SunSmart widget to your Secondary School's website?*

Yes

No

Uploading the SunSmart widget is an important part of the grant application process. If your school is unable to do so, please let us know why below:

5. How many students (aged 12-18) are enrolled at your school?*

6. What percentage of these students will benefit from the items purchased with the grant funds?

Part D - Your Budget

If successful, your organisation will receive up to $25,000 towards your shade structure or area. At the time that you submit this application, your organisation must have the remainder of the funds available to complete the project, if needed.

Does your organisation have the remaining funds available to complete the project?*

Yes

No

How will these funds be sourced? * (maximum of 500 characters)

Total amount applying for? (Up to $25,000 maximum)*

Part E - Payment

Payment Details

  • If your application is successful, funds will be transferred to the supplier upon receipt of a tax invoice in line with the quote(s) provided upon request of Cancer Council.
  • It may take up to four weeks for funds to be transferred to your nominated bank account.
  • Once you have been notified of your successful application, your project can be startedimmediately.
  • Project MUST BE COMPLETED by August 14, 2015 and acquittal returned October 30, 2015 (if you are successful, an acquittal form will be emailed with your letter of offer).

Part F - Approvals

Letter of Support and Authorisation

If you are an organisation please attach your registered or incorporated entity certificate to the email when you send your application. If you are a school, please attach your School Council's or Principal's letter of support.*

Agreement to media release and media coverage

Do you give your permission for media coverage if the grant is awarded?

Please contact me to discuss further.

Contact name for media enquiries:

Contact email for media enquiries:

Contact number for media enquiries. If supplying a landline please include area code

Declaration

I certify that the project is appropriate for the general facilities of my organisation and I am prepared to have the project carried out and to supervise the expenditure of funds. I understand that the project must be completed by 5pm (AEST) on 14 August 2015.*

I agree

Personal Confirmation

I confirm that the information provided in the Shade for Secondary Schools Grant Program application is true and correct.*

I agree

Name:

Position:

Signature:

Date:

Next Steps:

Please email this completed application form together with all the required attachments to .

Required attachments include:

  • Completed 'Shade audit' report;
  • An activesun protection or UV Policy(or documentation demonstrating that one is in development by the time applications close);
  • Letter of support from School Council and Principal; and
  • Evidence of the six (6)compliance strategiesyour Secondary School has met (1 of which is the active sun protection or UV Policy)

Please call our office on (02) 8063 4100 if you have any queries or would like further information about the Shade for Secondary Schools Grant Program. Good luck!