Organisation name:
Project title(please keep short):
Project Location:
ORGANISATION DETAILS
Contact Name:
Postal address:
Telephone:
Contact email:
Australian Business Number (ABN)
TAX STATUS (Discuss with Executive Officer if unsure)
GST – Registered / Yes / No
DGR – Deductible Gift Recipient / Yes / No
TCC – Tax Concession Charity / Yes / No
PROJECT SUMMARY
Brief project description:(A short summary of your project. - (Approximately 25 words)
Project Start Date / Project Finish Date
Total project cost: / $
Amount requested from SWCF / $
PROJECT CATEGORY(Please indicate no more than three categories that describe what the project covers)
TheArts Youth Education Environment Aged Care Health Disability Mental Health Small Community Projects Aboriginal Australian Community
Emergency Services Disadvantaged Other
PROJECT DETAILS (Please complete using dot points and no more than 300 words for each question)
WHAT IS YOUR PROJECT?
WHY IS THE PROJECT NEEDED (HOW DOES THIS PROJECT BENEFIT YOUR COMMUNITY)?

PLEASE FILL OUT THE BUDGET TABLE BELOW FOR YOUR PROJECT

Please see Grant Application Guidelines for an example of how to fill in the budget
PROJECT BUDGET
CASH INCOME – SOURCE OF FINANCE / $ / CASH EXPENDITURE / $
South West Community Foundation Grant Request
State/Federal/Local Government
Other Partners
IN-KIND SUPPORT - WHO / $ / IN-KIND SUPPORT - WHAT / $
TOTAL / TOTAL

(Note: Income and Expenditure totals must match)

SPONSORSHIP REQUEST
WHAT SPONSORSHIP ARE YOU REQUESTING FROM THE SWC FOUNDATION?
HOW MUCH ARE YOU ASKING FOR:
2018: $ / 2019: $ / 2020: $
WHAT ARE YOU OFFERING THE SWC FOUNDATION FOR THIS SPONSORSHIP?
(For example - Displaying the SWCF logo and sponsorship status on your website and in any communications relating to the activity; allow SWCF signage at the event/activity launch; provide speaking opportunities for the SWCF; etc).
PLEASE INDICATE OTHER SPONSORS YOU HAVE CONFIRMED FOR THIS ACTIVITY:
Bank Account Details:(If your project is selected for a grant, it will be paid electronically).
Account Name:
BSB:
Account Number:

 Tick this box if you have the delegation to submit this application on behalf of your organisation and you agree to acknowledge and understand that this application becomes the property of South West Community Foundation. You also agree that the Foundation may provide this application to other potential funding sources; if successful, to expend any funding within 12 months; that any variation to the project or variation to expenditure of funds be advised to the Foundation; that the Foundation is acknowledged on any communications about the project and funding provided, and that you will complete a Foundation Acquittal Form once the project is completed.

Thank you and the Foundation will be in contact as soon as possible regarding the outcome of your application assessment.

If you are having difficulty in accessing or sending this application online please contact

Karen Norris – Executive Officer on

or Mobile: 0437 756 082.

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