Youth Engagement Scheme GrantApplication form
Sport and Recreation (WA), a division of the
Department of Local Government, Sport and Cultural Industries
______
Applicant’s details
Organisation name:
Postal address:
Suburb:State: Postcode:
Street address:
Suburb:State: Postcode:
Preferred contact person
All application correspondence will be directed to this person.
Title:
First name:
Last name:
Position:
Business phone:
Mobile phone:
Website:
Email:
Businessdetails
Does your organisation have an ABN? Yes No
ABN:
You canfind your Australian Business Number (ABN) online.
Is your organisation registered for GST? Yes No
Is your organisation not-for-profit? Yes No
Is your organisation incorporated? Yes No
Incorporation number:
You canfind your incorporation number online.
(please attach a copy of the Incorporation Certificate)
Does your organisation have current public liability insurance? (please attach a copy of the certificate of currency) Yes No
Bank account name:
BSB number:
Bank account number:
Full name of financial institution:
Project information
Please keep your application concise.
Project title:
Project start date:
Project end date:
Project location:
Have you contacted your local Sport and Recreation (WA) office?
Yes No
If yes, who did you discuss your project with?
Consultant’s name:
Is this a new project?(If no, how will this build upon previous programs or funding?)
Yes No
Comment:
Child safeguarding information
Every child has the right to participate in sport and recreation within a safe environment. Information gained from the questions below will be used by the department to assist your organisation to work towards creating a child safe environment which includes complying with the Working with Children (Criminal Record) Checking Act 2004 (WWC Check). For more information and resources, please visit the Safe Clubs 4 Kids.
- Who within your organisation is responsible for signing WWC Check application forms and managing WWC Check outcomes?
- Which positions in your organisation do you require the person to obtain a WWC Check?
- How does your organisation record and monitor outcomes of the WWC Checks?
- Has anyone from your organisation attended a Safe Clubs 4 Kids workshop or any other workshops/training in relation to keeping children safe?
- Does your organisation have any other strategies to ensure children are safe within your organisation? (E.g. Code of conduct, pick up and drop off rules, supervision of staff/volunteers, Child Protect Policy)
Our organisation is compliant with the Working with Children (Criminal Record) Checking Act 2004.
Yes ☐ No ☐
1. Grant amount requested
Amount of funding requested
(Excluding GST)
Contribution from organisation
(Excluding GST)
Sponsorship from other organisations
(Excluding GST)
Program budget total excluding GST
2. Project description
Provide an overview of the project and project components including where it will be delivered, what it will encompass, how many people you anticipate being involved, etc. Please include project objectives and outcomes and ensure all essential project components (as per grant guidelines) are addressed.
3. Project implementation
Provide a plan to indicate what will be implemented as part of the project and how it will be achievedincluding a timeline.
4. Rationale
Outline the evidence and rationale supporting your project and approach, including when and where program delivery is occurring (e.g. is program delivery occurring during high risk times and in low socio-economic areas?).
5. Target group
Who is the target group? How will you engage them in the program? What experience does your organisation have in engaging this group? Will program delivery occur in low socio-economic areas?
6. Partnerships
What funding partnerships and/or in-kind support have been committed to this project?
7. Community engagement
What consultation with local community members, service providers and other relevant groups has occurred? Please list all below.
Group/person / Consultation medium/ technique / OutcomesE.g. Western Australian Police / Face to face meeting / WA Police to support the project through participation in a number of basketball sessions and referring young people into the program.
8. Capacity to deliver
Does your organisation have sufficient staff and resources to deliver the project? Can your organisation demonstrate experience in delivering similar projects? Can this program still be delivered if the department cannot commit to fund 100% of your requested amount?
9. Risk management
Complete a risk management review and identify strategies to address the risks.E.g.are all your participants covered by insurance?A template risk matrix and risk register are available on the Sport and Recreation (WA) website.
10. Project legacy and evaluation
What strategies are in place to sustain project outcomes beyond the funding period? How will you evaluate project objectives?
11. Project budget
Please list all anticipated costs of your activity in as much detail as possible:
Revenue
/ Proposed amount / Funding sourceRequested from Sport and Recreation (WA) /
Sport and Recreation
Supplied by your organisationFrom any other organisations
(please specify)
Participant fees (if relevant)
Other revenue items
Total revenue
Expenditure item (e.g. administration costs, venue hire, program coordinator fees, workshop facilitator)
/ Proposed amount / Funding sourceTotal expenditure
12. Privacy statement and statement of disclosure
The Organisation acknowledges and agrees that this Application and information regarding it is subject to the Freedom of Information Act 1992 and that the Grantor may publicly disclose information in relation to this Application, including its terms and the details of the Organisation.
Any information provided by you to the department can be accessed by you during standard office hours and updated by writing tothe department or calling 08 9492 9700. All information provided on this form and gathered throughout the assessment process will be stored on a database that will only be accessed by authorised departmental personnel and is subject to privacy restrictions.
The department may wish to provide certain information to the media for promotional purposes. The information will only include the applicant’s club name, sport, location, grant purpose and grant amount.
Applicant’s certification
I certify that:
The information supplied is to the best of my knowledge, true and correct.
I have the authority, as vested by the Board/Committee/Council/CEO, to submit this application by electronic transmission.
Name
Position
Signature
Date
If you have any queries about your eligibility or the details required when applying for this grant, please contact the department on 08 9492 9700 or
Please return a completed and signed copy of this application to:
Sport and Recreation (WA)
Department of Local Government Sport and Cultural Industries
PO Box 329 LEEDERVILLE WA 6903
Application checklist(for your information only)
Have you discussed the project proposal with a member of the Department’s Community Inclusion Team or the nearest regional office prior to submitting an application?
Yes NoComment:
Does the proposed project address all essential components as outlined in the grant guidelines?
Yes NoComment:
Does your organisation propose appropriate strategies to engage the target group?
Yes NoComment:
Does your organisation have demonstrated experience in working with disengaged youth?
Yes NoComment:
Have you engaged other community organisations and/or departments to develop funding partnerships and/or in-kind support?
Yes NoComment:
Has your organisation demonstrated its engagement with local community members and/or community organisations that work closely with the target group?
Yes NoComment:
Has your organisation demonstrated it has the capacity (human/financial resources) to deliver the project?
Yes NoComment:
Are there strategies in place to ensure project outcomes will be sustained beyond the funding period? Has your program developed an evaluation process?
Yes NoComment:
Budget
Is the project budget comprehensive and details all reasonable income (e.g. participant fees, sponsorship, other grants and expenditure (venue hire, course fees, employment)?
Yes NoComment:
Are all project budget items requested to be funded by the department eligible?
Yes NoComment:
Note: Funding cannot be used to purchase ineligible items.