New School ($4000) Or Per Capita(Up to $120 Per Student) Grant

COMMUNITY LANGUAGES PROGRAM

New School ($4000) or Per Capita(up to $120 per student) Grant

Application Form

For the 2018 School Year

Deadline 4.00pm, Friday 9 March 2018

Please read the funding guidelines carefully and speak to a member of the Office of Multicultural Interests (OMI) Community Engagement and Funding team before completing an application.

Contact (08) 6552 1603 or email for further information and assistance.

Grant category

Select the grant category you are applying to. / New School ☐
(in operation between 12-52 weeks) / Per Capita ☐
(in operation at least 12 months)

Eligibility

Are you an incorporated association or not-for-profit organisation based in Western Australia?You are required to attach a copy of the organisation’s Certificate of Incorporation, or equivalent. / Yes ☐ No ☐
Does your organisation meet all of the eligibility requirements as outlined in the funding guidelines?You are required to attach a copy of the constitution or school charter stating that the organisation’s purpose is to provide language education. / Yes ☐ No ☐
Is your organisation up to date with funding acquittals and reporting with OMI or the Department of Local Government, Sport and Cultural Industries? Organisations with outstanding funding acquittals and reporting are not eligible. (Check with the OMI Funding team if you are not sure.) / Yes ☐ No ☐

If you have answered ‘No’ to any of these questions, please contact the OMI Funding team on
(08) 6552 1603 or email

Applicant details

Organisationdetails

This is the group undertaking the school activities.

Legal name of organisation: / Click here to enter text.
School name (if applicable): / Click here to enter text.
Postal address: / Click here to enter text.
Suburb: / Click here to enter text. / Postcode: / Enter text.
Telephone: / Click here to enter text.

Organisation contact

This is the person legally authorised to enter into contracts on behalf of the organisation.
For example, the chairperson, president or equivalent officer.

Name: / Click here to enter text.
Position: / Click here to enter text.
Telephone: / Click here to enter text.
Mobile: / Click here to enter text.
Email: / Click here to enter text.
These contact details may be placed on the OMI database: / Yes ☐No ☐

Note: Personal information collected by OMI is handled in accordance with the Privacy Act 1988

Community Language School contact

This is the person responsible for the operations of the school.

Name: / Click here to enter text.
Position: / Click here to enter text.
Telephone: / Click here to enter text.
Mobile: / Click here to enter text.
Email: / Click here to enter text.

School information

Provide the year and month your schoolcommenced operation.

Click here to enter text.

List the language/s taught at your school.

Click here to enter text.

Tuition fees

Fees per student per year: / Click here to enter text.
Average tuition fees per family per year: / Click here to enter text.

Management committee

Provide the details of the school’s management committee and each member’s role. The applicant organisation’s board or management committee must include representation from at least one member of the language group’s community, and at least one parent of a student at the school.

Name / Role / Community member / Parent of a student
Click here to enter text. / Click here to enter text. / ☐ / ☐
Click here to enter text. / Click here to enter text. / ☐ / ☐
Click here to enter text. / Click here to enter text. / ☐ / ☐
Click here to enter text. / Click here to enter text. / ☐ / ☐
Click here to enter text. / Click here to enter text. / ☐ / ☐
Click here to enter text. / Click here to enter text. / ☐ / ☐

Language classes

Student enrolments

Number of students enrolled in the 2018 school year: / Click here to enter text.

You are required to attach a copy of your student enrolment list in English, including identified WACE students and their corresponding student reference number if applicable.

Classes information

Location address / Code* / Day/s of the week
Click here to enter text. / Text. / Text.
Year level / Number of
classes per year / Hours of language instruction per class / Average number of students per class
Text. / Text. / Text. / Text.
Text. / Text. / Text. / Text.
Text. / Text. / Text. / Text.
Location address / Code* / Day/s of the week
Click here to enter text. / Text. / Text.
Year level / Number of
classes per year / Hours of language instruction per class / Average number of students per class
Text. / Text. / Text. / Text.
Text. / Text. / Text. / Text.
Text. / Text. / Text. / Text.
Location address / Code* / Day/s of the week
Click here to enter text. / Text. / Text.
Year level / Number of
classes per year / Hours of language instruction per class / Average number of students per class
Text. / Text. / Text. / Text.
Text. / Text. / Text. / Text.
Text. / Text. / Text. / Text.

*Codes:G: Government schoolC: Catholic schoolI: Independent schoolO: Own building

Term dates

Term / From date: / To date:
Term 1 / Click here to enter text. / Click here to enter text.
Term 2 / Click here to enter text. / Click here to enter text.
Term 3 / Click here to enter text. / Click here to enter text.
Term 4 / Click here to enter text. / Click here to enter text.

Teacher information

Qualifications
Number of teachers registered with the Teachers Registration Board of WA / Enter text.
Number of teachers with overseas / interstate teaching qualifications / Enter text.
Number of teachers without teaching qualifications / Enter text.
Total number of teachers / Enter text.

Professional development

Provide details of school staff who attended the OMI Professional Learning Program (PLP) workshops in the previous school year.

Staff name / Email address / Workshop date / Workshop name
Click here to enter text. / Click here to enter text. / Enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Enter text. / Click here to enter text.

Provide details of professional learning activities planned and/or to be attended by school staff in the upcoming school year.

Click here to enter text.

Curriculum / learning program

Provide a brief summary of the planned learning program for the upcoming school year that includes language outcomes you aim to achieve, and any planned activities or events that occurred during the year. You are required to provide a copy of the school’s curriculum in English, and at least one sample lesson plan for each learning group level in English. Curriculum and planning templates are available for your use on the ‘Community Languages Program’ page at

Click here to enter text.

Community need

Provide a brief overview of the community or communities that benefit from your school, and the role of your school in the community.Include or refer to evidence of this, such as attached letters of support from the community, or copies of feedback reports that have been undertaken.

Click here to enter text.

Outline how your school engages staff, students and parents of the school, and how your school will engage the broader community. This may include a promotional plan for the school, or delivering community events or activities. Planning templates are available for your use on the ‘Resources’ page at

Click here to enter text.

Performance evaluation

Provide a brief summary of planned processes to evaluate the performance of the school. This may include surveys for teachers, parents, students and administrators.

Click here to enter text.

Budget

It is important to show how you plan to spend the grant and whether you expect to receive any other income to support your school. The ‘grant request amount’ will depend on the category to which you are applying.

The New School grant amount is $4000, or
The Per Capita grant amount is up to $120 per student. Schools with students completing languages courses as part of their Year 11 or 12 WACE studies can apply for a bonus of up to $120 for each student completing this level of study. To qualify for the WACE bonus, schools must provide evidence of student enrolment in Years 11 and 12 languages study.

Use the table below to show where the money for your school is coming from and how it will be spent. Identify which budget items the grant will be allocated towards. If you are getting funds from other sources to support your school, it is important you show evidence of where the money is coming from.

Do not include GST in your costings.

Note: Please also include your organisation’s cash and ‘in-kind’ contributions.

New School grant request amount: / $ Enter text.
Per Capita grant request amount: / $ Enter text.
Per Capita WACE bonus amount: / $ Enter text.
Total project amount: / $ Enter text.
(1)
Budget Items
(i.e. what the money will be spent on.) / (2)
This Grant Request
($) (ex. GST) / (3)
Other Funding Amount
($) (ex. GST) / (4)
In-Kind Support - Estimate the dollar value of the in-kind support ($) / (5)
Source & Status of Other Funding or
In-kind Support.
State if confirmed
or unconfirmed
Example only:
Printing / $1000 / $500 / $500 / Print shop sponsorship
Confirmed
Enter text. / Enter text. / Enter text. / Enter text. / Enter text.
Enter text. / Enter text. / Enter text. / Enter text. / Enter text.
Enter text. / Enter text. / Enter text. / Enter text. / Enter text.
Enter text. / Enter text. / Enter text. / Enter text. / Enter text.
Enter text. / Enter text. / Enter text. / Enter text. / Enter text.
Enter text. / Enter text. / Enter text. / Enter text. / Enter text.
Total: / Enter text. / Enter text. / Enter text.

Organisation taxation and banking details

Taxation details

ABN: / Click here to enter text.
Is your organisation registered for GST? / Yes☐No☐
Is your organisation incorporated? / Yes☐No☐

If you do not have an ABN, please attach a completed ‘Statement by a Supplier form’.
These forms can be accessed at

Bank account details

Bank name: / Click here to enter text.
Bank branch:
(suburb) / Click here to enter text.
Name of bank account:
(e.g. Youth Group Inc.) / Click here to enter text.
BSB number:
(must be 6 digits) / Click here to enter text.
Bank account number:
(up to 9 digits) / Click here to enter text.

I confirm that the above taxation and banking details are true and correct:

Name: / Click here to enter text.
Signature: / Click here to enter text.
Date: / Click here to enter text.

Grant Conditions

If successful, this application becomes the legally binding grant agreement and the grant is provided under the following terms and conditions:

The grant is to be used solely for the specified purpose approved by the Office of Multicultural Interests during the funding period. Funding may not be used for capital purposes such as buildings, building repairs, maintenance or renovations; or for domestic or international travel; or to support faith-based instruction or activity.
If you wish to change the approved purpose or seek an extension of the funding period you must obtain the Office of Multicultural Interests’ prior written approval.
Any part of the grant funds that are not used in accordance with Condition 1 must be repaid to the Office of Multicultural Interests unless you obtain prior written approval.
If you cease carrying out the activities for which the grant was made or if the Office of Multicultural Interests has terminated the arrangement on account of your breach or breaches of these conditions then:
the balance of the grant monies unspent must be repaid to the Office of Multicultural Interests; and
any property acquired with the grant monies must be transferred to another not-for-profit organisation with similar objects and purposes to your organisation, provided the Office of Multicultural Interests’ prior approval has been given.
Providing you with a grant does not mean you are entitled to any further funding.
The Office of Multicultural Interests will not be held responsible for the success of the approved purpose for which the grant is provided or for any losses or additional costs incurred that are associated with the approved purpose.
You must provide the Office of Multicultural Interests with any documents or information relating to the grant or the approved purpose that we ask for within ten (10) business days of receiving our request.
You must meet any payment conditions and/or reporting requirements as specified by the Office of Multicultural Interests.
You must allow the Auditor General for the State of Western Australia, or an authorised representative, to have access to and examine your records and information concerning this grant.
You must comply with all Local, State and Commonwealth laws applicable to the approved purpose.
You must ensure that your organisation and all employees and volunteers comply with the Working with Children (Criminal Record Checking) Act 2004 and be committed to becoming a child safe organisation.
The Office of Multicultural Interests is not liable for any accident or negligence resulting in any claim or damage arising from activities undertaken as part of the grant.
Recipient organisations are required to be appropriately incorporated and be responsible for their own insurances. This includes, but is not limited to, Public Liability, Workers Compensation, Volunteer Insurance and Professional Indemnity.
An acknowledgement of funding assistance provided by the Office of Multicultural Interests must be made, where appropriate, by:
(logo) including on all promotional material produced for the Project (including without limitation all flyers, programs, brochures, certificates, letterhead, tickets, posters, newsletters, media advertising and other printed materials) the ‘Supported by’ the Office of Multicultural Interests badge which can be downloaded in the format required from
(acknowledgement) including on online and social media promotions of the Project, where appropriate, a prominent acknowledgment that reads: This project has been supported by the Office of Multicultural Interests;
(invitations) providing the Minister for Citizenship and Multicultural Interests or the Minister’s representative, and an Office of Multicultural Interests representative an invitation to attend any official functions in relation to the Project;
(verbal) in any announcements, speeches or official presentations in relation to the Project, include a verbal acknowledgement of the contribution and assistance of the Office of Multicultural Interests;
(signage) allow the Office of Multicultural Interests to display signage at the site of any official functions in relation to the Project, which signage will be placed by the grant recipient in the most focal areas possible;
(merchandise) it will display and distribute during the Project at the site of the Project, any promotional materials provided by the Office of Multicultural Interests for the purpose of distribution in the manner specified by the Office of Multicultural Interests;
(contact details) it will allow the Office of Multicultural Interests to include details of the project/event including contact information as provided in the application on its website;
(promotion) it will provide the Office of Multicultural Interests copies of all project/event promotional material a minimum of 21 days before the project/event occurs (if requested). Examples of promotional materials include press releases, posters, postcards, programs and pamphlets. The Office of Multicultural Interests may use the promotional material submitted for non-commercial promotional purposes only.
Any individuals involved with the project must not be exposed to significant promotions for alcohol or unhealthy foods and drinks during the project.
Goods and Services Tax
For the purposes of Conditions 17 and 18:
“GST” means the goods and services tax applicable to any taxable supplies, as determined by the GST Act; and
“GST Act” means New Tax System (Goods and Services Tax) Act 1999 (Cth) and includes all associated legislation and regulations;
the terms “supply”, “tax invoice”, “taxable supply”, and “value” have the same meanings as in the GST Act.
If the supply of anything under the grant agreement is a taxable supply under the GST Act, the grant funds shall be inclusive of GST.
If the parties agree that the Office of Multicultural Interests will issue the organisation with a Recipient Created Tax Invoice (RCTI), then the parties hereby agree that:
The department will issue an RCTI in respect of GST payable on the supply of the project and the organisation will not issue a tax invoice in respect of that supply;
The organisation warrants that it is registered for the purposes of GST and will notify the department in writing if it ceases to be registered for the purposes of GST during the term of the agreement;
The department warrants that it is registered for the purposes of GST and will notify the organisation in writing if it ceases to be registered for the purposes of GST, or if it ceases to satisfy the requirements of the GST Act during the term of the agreement; and
The department will indemnify and keep indemnified the organisation for GST and any related penalty that may arise from an understatement of the GST payable on the supply of the project for which the department issues an RCTI under the grant agreement.
Where applicable, the total grant funds provided by the Office of Multicultural Interests will include an amount to cover any liability for GST.
Recipient organisations may be subject to site visits from the Office of Multicultural Interests staff with at least 24 hours’ notice.
If you breach any of these terms and conditions, the Office of Multicultural Interests can terminate the arrangement at any time without giving you prior notice.

Declaration