Office Use Only

Grant Reference Number
Date Received
Acknowledged

Grants for Women Program Acquittal Report

General Information

Grant Details

Name of Project
Grant Amount / $

Applicant’s Details

Name of organisation
Postal address
Suburb / Postcode
Telephone

Contact Person – responsible for the daily co-ordination of the project

Name
Position
Telephone
Mobile
Email

Declaration

I declare that the Grants for Women funding of $______(ex GST) provided by the Departmentof Local Government andCommunities has been spent in accordance with the purpose and conditions for which it was granted and that the financial statements are a true and fair record of the transactions for this project.

Name
Signature
Position
Date

Project Evaluation

Please read all of the questions before you start writing your responses. If you feel that you will need more space than that provided, please provide attachments with your Evaluation Report.

1.Briefly describe what the grant funds were expended on

2.What date(s) did you run and complete your project?

3.Were other partners involved with the project? Yes ☐No ☐

If yes, please complete the table below

Organisation Name / How the organisation was involved
e.g XYZ Council / On organising committee, provided venue free of charge, advertising

4.Which main group did each participant represent?

Diversity / Number of Participants
Indigenous Women
Transgender Women
Senior (60+)
Women from culturally and linguistically diverse communities
Women with disabilities
Young women
Women working in predominately male environments
Other (please specify)
Not stated
Total

5.Please comment on how successful your organisation was in achieving the following intended outcomes:

  • The project enhanced the capacity of women’s economic independence

Strongly Agree☐Agree☐Disagree ☐Strongly Disagree ☐Neither☐Unsure ☐

  • The project enhanced women’s leadership

Strongly Agree ☐Agree ☐Disagree ☐Strongly Disagree ☐Neither☐Unsure ☐

6.Please describe the most significant change that happened for women as a result of the project.

7.Please outline any challenges you faced on the delivery of your project.

8.What acknowledgement has the Department of Local Government and Communities received as a result of this grant? (please attach a copy of any media release, brochures etc.)

9.Please comment on the grant process and provide any comments/suggestions for future Grants for Women Program.

Financial Reporting

BUDGET
$ / ACTUAL
$
INCOME
Grants for Women
Other Grants
Sponsorship
Donations
Other (include any in-kind contributions)
TOTAL INCOME
EXPENDITURE
Eg. Advertising
Accommodation/meals
Presenter/speaker
Equipment
Other (include any in-kind expenditure)
TOTAL EXPENDITURE
SURPLUS*/DEFICIT

*Any unused Grants for Women Program funds are to be returned via cheque and made out to the

’Department of Local Government and Communities’. Please then post to:

Grants and Contracts Officer

Department of Local Government and Communities

GPO Box R1250

PERTH WA 6844

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