31 March 2009

MLC Community Foundation

2009 Grant Application Form

Note: please complete this questionnaire with specific, short answers. Please submit this form as a word document and attach to your email submission.

Please ensure that you keep to the numbering and order as below. Please do not delete any questions.

About the organization

  1. Your organisation’s name, ABN, website address and logo:
  1. Contact name, job title telephone numbers and email address:
  1. Your current corporate partners:
  1. The States in which you currently operate/deliver services:

5.  Does your organisation hold deductible gift recipient (DGR) status? (This is mandatory)

  1. Your Vision, Mission and Values:
  1. What your organisation does in general and specific to Mental Health and Wellbeing:

8.  Which banks, financial institutions or wealth management companies do you have a partnership or public relationship with? What is the nature of the relationship/s?

  1. Please confirm that you have read and understand the section on ‘Planning your application’ and your organisation fits this criteria:

About your Program

1.  Name the specific program/s or activities that this submission is requesting funds for?

2.  How much funding are you requesting? (up to a maximum of $50,000 per organisation)

  1. Is this program current or proposed? If current, how long has it been running for? What key achievements can you claim? Please provide a plan of activities, outcomes and financials if available.

4.  Please detail the MLC staff volunteering opportunities that you can offer? What sort of things could we do for you?

  1. Please detail how your organisation and programs a) are innovative b) provide advice and empower people c) have an educational component d) involve investing in the future and e) are preventative.
  1. How does your program enhance the Mental Health and Wellbeing of Australian Families? What tangible, community outcomes will the program deliver? How are you going to measure these?

7.  Are there any questions you have for us?

Anything else / supplementary (not mandatory)

You are welcome to submit any additional items you feel may be relevant.

This may include:

·  video/DVD/printed material of proposed program if available

·  media stories that you have generated relevant to your program

·  any research to validate the rationale for your program (if it is new/proposed)

·  your organisational profile or credentials document/PowerPoint/DVD

·  your annual report and accounts

·  anything else that you think is appropriate

Questions

If you have any questions please email and we will answer them as soon as we can.

Thank you

Thank you for taking the time to respond to our questions. We look forward to reviewing your submission.

MLC Community Foundation 2009 Grants Program – Application Form 1