Opportunities for Carlton (OFC) Fund

2013 Application Form

Organisation that will manage the project
Organisation:
Address: / Postcode:
Tel: / Website:
Do you have an auspice? Yes No
Organisation:
Details of Contact Person
Name: / Position:
Address: / Postcode:
Tel: / Mobile: / Email:

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Opportunities for Carlton (OFC) Fund

2013 Application Form

Where will your project take place?

Organisation or Auspice ABN:
Registered for GST? Yes No
Incorporation Number:

Provide a brief description of what your organisation does:

How many people will participate in the project:
How many will be Carlton residents, traders or workers:

Title of Project

Brief Summary of Project (max. 50 words)

Amount of funding being applied for:

$ (exclusive of GST)

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Opportunities for Carlton Fund

1. What is the aim or purpose of your project?
2. Applications made to the OFC Fund are required to link to the goals for Carlton, as identified in the OFC CommunityPlan. Which of these community priorities does your project link to:
To establish and support sustainable and effective systems for community participation in decision-making
To support community knowledge and skill development and the participation of the community in decision making processes
To develop social networks, structures and infrastructure to bring people together in Carlton.
To build Carlton as a community that responds to the changing populations, and ensure that people can connect to and access services and activities
To build Carlton as a great place to live, visit and enjoy and to ensure that cultural opportunities are enjoyable and accessible
To improve ecological sustainability in Carlton
To create an inclusive and participatory Carlton community through volunteering.
To respond to youth issues and build responses in partnership with the Carlton community.
To help the Carlton community develop improved skills and access to information and communications technology (ITC)
To increase lifelong learning opportunities in Carlton and ensure that there is infrastructure to support this
To improve employment pathways for disadvantaged communities
To improve access to appropriate, affordable health services
To improve Carlton’s social inclusion benefits to community safety, diversity and mental health
To celebrate and reflect community diversity around Carlton.
To ensure that community and recreation services are responsive to Carlton residents needs
3. What is the need for this project and how have you identified this need? eg. research, literature, consultation, anecdotal, surveys (link answer to Carlton community needs)
4.How will you deliver your project (what will you do) and how will you achieve your aims?
Please outline the project activities / milestones and when they will be achieved in the table below
Project Activities / Milestones / Timeline
5. What are the outcomes and benefits of this project for Carlton, for project participants and for your organisation?
6. What partnerships have you formed for this project? Describe how you will involve Carlton residents, traders, students or workers in this project.
7. How does the project strengthen the local community?
Describe how the project addresses a community need either not being addressed by the local community, or complement a need that is already being met in the community?
8. How will your project provide opportunities that are accessible and inclusive for people with disabilities, people from a range of social, economic, educational, faith and/or language backgrounds to come together?
9. How will the project be evaluated - how will you know if you have met your stated aim and outcomes?

Outline your project budget – note this is not your organisational budget, but specific to the actual project you are applying for.

Proposed Project Expenditure / Amount $
Additional Staff Costs ($per hour x no. of hours x no. of weeks)
Presenter / consultant costs
Materials
Hire Charges (eg venue, bus)
Promotional / advertising
Catering
Printing
Other Costs (please specify)
In kind contribution to this project (please specify)
Total cost:
Proposed Project Income / Amount $
Ticket sales
Fund raising activities / Donations
Other (please list)
Grants / Subsidies
–City of Melbourne Grant application amount
–Other grants (please specify)
–
Total income:
Note: Total cost should equal total income

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To be completed by all applicants:

Checklist

All questions answered.

Copy of Certificate of Currencyfor Public Liability Insuranceor other relevant insurance to cover activities are enclosed. *

All previously funded projects have been fully acquitted.

If applying for a large project, name of partners and Carlton Community Action Plan activity you will be addressing have been identified.

Relevant brochures or promotional material enclosed.

* Note: Applicants without Public Liability Cover or other relevant insurance to cover their activities are required to identify the risks associated with their project and table how these risks will be managed.

Please attach your Risk Assessment with your application if you do not have insurance.

Your Privacy

The City of Melbourne is committed to protecting your privacy. The personal information requested on this form is being collected by the City of Melbourne for the purpose of assessing your application in the OFC Grants program. It will not be disclosed to any external party without your consent, unless required or authorised by law. If the personal information is not collected, Council may have difficulties in contacting you in a timely manner in relation to your application.

If you wish to alter any personal information you have supplied to the City of Melbourne, please telephone 9658 9944or email .

The names, project names and funding amounts of successful applicants will be made publically available, including publication on Council’s website and in Council media releases.

Access our privacy statement at .

Declaration

I hereby apply for funding to the Opportunities for Carlton Fund and acknowledge that if successful in this application, my organisation agrees to comply with the guidelines set out by the City of Melbourne and to submit necessary acquittal documentation when the project has been completed.

I also acknowledge that all details supplied in this application form and in the attached documents are true and correct and that the application has been submitted with the full knowledge and support of the Committee of Management.

Signature:
Name:
Position:
Date:
APPLICATION SUBMISSION

Submitting your application:

By Email:

By Mail:

Opportunities for Carlton Project

Community Development Department

City of Melbourne – P.O. Box 1603

Melbourne 3001

In Person:

Council House, Level 3,

200 Little Collins Street,

Melbourne, 3001

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