John Wallis Foundation 2017 Small Grants Application Form
ORGANISATION DETAILSName of organisation undertaking the Project
Name of organisation who would receive and manage the funding?
(if different to above)
Name of partner organisations(if any):
Contact person:
Postal address:
Email address:
Telephone contact:
PROJECT DETAILS
Project Name:
Project start date: Project Completion date:
Amount Requested: Total Project Cost
1. Provide a brief project description (a short summary of the project in 1 – 2 sentences or dot points)
2. Where is your project located? If your project is located in one of the DOTE report areas of disadvantage could you please identify which geographical area?
3. What is the project aiming to do?
4. What are the key steps you need to take to achieve this aim?
5. Why is there a need for your project?
6. How will the project demonstrate the focus of the John Wallis Foundation 2017 Small Grants Program? - Addressing disadvantage through local and community leadership.
7. Who will benefit and how?
8. What are the expected outcomes? (what do you want to achieve, include both immediate and longer term)
9. How will you know if these outcomes have been achieved? (discuss evaluation or measurement of project’s effectiveness)
10. Outline the project timelines and if appropriate project stages
11. How did you hear about the John Wallis foundation Small Grants Program? JWF website, JWF e-bulletin or newsletters, local government networks, community networks, previously received or applied for a grant, other (please highlight)
PROJECT BUDGET
12. How will the support from the John Wallis Foundation be utilised?
(i.e. please complete the Budget Proposal below. The Budget must balance - total income = total expenditure).
INCOME / $ / Notes
Amounted requested from John Wallis Foundation
Any Other Source of Income
In-kind contributions
Estimated value for non-cash contributions such as services, equipment, time and material
TOTAL INCOME
EXPENDITURE
Item (Breakdown of individual items such as salaries, equipment, travel/transport, administration) / $ / Notes
In-kind contributions
(As Above)
TOTAL EXPENDITURE
Please sign and return one copy of this proposal and any attachments to:
Liz McAloon
Executive Officer
The John Wallis Foundation
By post:
The John Wallis Foundation
PO Box 2075
Rangeview VIC 3132
By Fax: 03 9873 5457
By email:
Name of key contact person:
Signature:
Date: