Regional Arts Development Fund

COMMUNITYPROJECTGRANTAPPLICATIONFORM

APPPLICANT DETAILS / ApplicantType Individual Group/UnincorporatedBody Organisation
Have youoryourgroup/organisationpreviouslybeen successfulforaRADFGrant? Yes No
Ifyouweresuccessful,wasthatgrantsuccessfullyacquitted? Yes No
INDIVIDUALS
Title Mr Mrs Ms Other(pleasespecify):
Name
Age group under 18 18 – 25 25 – 55 55 +
GROUPS/UNINCORPORATEDBODIES/ORGANISATIONS
Name
LegalName(OrganisationsOnly)
LegalStatus(Organisations Only)
ContactPersonTitle Mr Mrs Ms Other(pleasespecify):
ContactPersonName
ContactPersonRole
CONTACT DETAILS
StreetAddress
Suburb State Postcode
PostalAddress
Suburb State Postcode
Mobile Home
Email
Website
PROJECT SUMMARY
ProjectTitle
GrantCategory 1. Community Project 2. Council Initiated Project
GrantRound2016-17 Round1 Round2
ProjectBrief(Describetheprojectin 20 wordsorless)
RADFGrantRequested:$ TotalProjectCost:$
StartDate / / EndDate / / OutcomeReportDue / /

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website:

PROJECTDETAILS 40%

WHAT ARTFORM?
Whatistheartformof yourproject?SelectONE / CommunityArtsandCulturalDevelopment Music Writing Dance
VisualArts,CraftandDesign Theatre Heritage Multi-arts
Whatisyourproject? Whatdoestheproject involve,whatactivities will yoube undertaking?
WHICH TYPE OF ACTIVITY?
Pleaselistthenumberofactivities involved / TYPEOFACTIVITY / QTY / TYPEOFACTIVITY / QTY
Workshops(creative) / Performances
Creativedevelopment of newwork / Placemaking
Culturaltourism / Professionalor careerdevelopmentactivity/opportunity/training
Events and festivals / Communityconsultation,arts researchorpolicy development
Exhibitionsandcollections / Community training sessions for artists and cultural workers
Heritage / Other(pleasespecify):
WHERE IS YOUR PROJECT?
Wherewill youundertake yourproject?Town, regional locationetc.
Ifyourprojectisnot beingheldin theCHRC area detailhowthelocal communitywillbenefit.

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website:

WHO ARE YOU?
Tellusabout whowillbe involvedwithyour project.Whoarethe artists/organisations involved?
Tellusaboutyour expectedaudienceor participantnumbers. / ParticipantNumbers / Participantsareconsideredtobethoseactively engagedinarts activities (eg. creativeworkshopparticipants)
Audiences havemorepassiveengagement (eg.audienceatanexhibition)
AudienceNumbers
Indicateifyourproject specificallytargetsanyof thegroupslistedas participants,audience,or in thedevelopmentof the project. / Childrenaged0-11years Aboriginalpeoples

Youngpeopleaged12-30years TorresStraitIslanderpeoples

Seniorsaged55 yearsorover AustralianSouthSeaIslanderpeoples

Women Peoplefrom culturallyandlinguisticallydiversebackgrounds

Men Peoplewitha disability

RegionalQueenslanders EmergingArtists/Culturalworkers

Tourists EstablishedArtists/Culturalworkers
Describehowyouare engagingortargetingthe group/s.
WHEN IS IT?
Whenisyourproject takingplace and how are you advertising it?
Listeachstageof the projectfromstartto finishandlist whenyou
expectto completethat stage
Whatisyourplanning timeframe?
Ifthereisamain activityorevent when is it?
Willyouneedto completeanything after the actualproject suchas documentation?
Whenisyouroutcome reportdue? / ProjectStage / ExpectedCompletionDate
OutcomeReportDue(8 weeks fromenddate)

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website:

WHY?
Whyareyouundertaking thisproject?
Doesyourproject addressanyof the CHRCLocalArts andCulturePriorities? / Priority1:Arts
Priority2: Culture
Priority3:Heritage
Outlineanyevidencefor genuinecommunity interestandlocalsupport forthis project.
Whatresultsdo you expectfromthe project?
Howwill yourproject makea positive contributionto the community?
HOW?
Howwill youmeasure success?Indicatehow youwillcapture audience/participant/part nerfeedback.
(eg.surveys,interviews, commentbox,debrief)
Howwill youaddressany risks:WHS,insurance, licensesetc.
CONTRIBUTIONSTOTHELOCALECONOMY 20%
Indicateanyartistsorartsworkersbeingemployedby yourproject.
Usethesefiguresto assistincompletingyourbudgetbytransferringtothecorrespondingbudgetsections.
Refertothesupportmaterialchecklistforessentialdocumentsneededforeachartsworkerbeingpaid withRADFfunds
NAME/ROLE / RATE OF PAY ($/hror$/week) / TOTALVALUE / RADF CONTRIBUTION / INKIND CONTRIBUTION
TOTALS / $ / $ / $
Howmanyvolunteers/unpaidworkersareinvolvedin yourproject?
PROJECTBUDGET 20%
RADFGRANT REQUESTED / $ / BudgetTips
Usewholedollarsonly
GST: ifyouareregisteredforGST,your figures shouldbeexclusiveofGST.
The totalexpenditureand totalincomemust beequal. Thetotal RADFgrant shouldbelistedtwice,oncein the incomecolumnandonceintheexpenditure column
Use thecolourcodes for figures that shouldequal
Ask theRLOforassistanceif requiredor seethebudget factsheet
TOTAL EXPENDITURE / $
TOTAL INCOME / $
EXPENDITURE (pleaseprovidedetails) / TOTALVALUE / RADF CONTRIBUTION
Professional
Fees / Travel
Accommodation
Salaries,Fees, Allowancesetc.
Project Costs (materials, preparationetc.)
Promotion Marketing Documentation
Administration
EXPENDITURE TOTALS
INCOME
(pleaseprovidedetails) / TOTALVALUE
RADFGrant Requested
Earned Income
- ticket sales
-workshop fees
OtherGrant/s (indicateif approvedwith(A)
Contributions. & Partnerships
Donations, sponsorship etc.
In-kindContributions
(Volunteer hours etc)
INCOMETOTAL

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website:

FINANCIAL INFORMATION
Completethissectionifyou/yourorganisation/grouphaveanABNandareresponsibleforthefinancial managementof thisgrantifsuccessful.IfyoudonothaveanABNpleasecomplete‘AuspicedApplication’
ABN / GSTRegistered Yes No
RegisteredName
TradingName(if relevant)
AUSPICED APPLICATION / CompletethissectionifyoudoNOThaveanABNandyouarenominatinganaccountableorganisationor individualto administerthegranton yourbehalf.
Pleasenote:Boththeapplicantand theauspicingorganisation/individualareconsideredresponsiblefor ensuringtheacquittalof grantsandbothcouldbedeemedineligibletosubmitfurtherRADFapplicationsuntil allgrantshavebeensatisfactorilyacquitted.
Whoisyourauspicingarrangementwith? an incorporatedorganisation anindividual
Nameof AuspiceBody
ABN / GSTRegistered Yes No
CONTACTPERSON
Title Mr Mrs Ms Other(pleasespecify):
Name
Role(if relevant)
PostalAddress
Suburb State Postcode
Email
CERTIFICATIONBYAUSPICINGORGANISATION/INDIVIDUAL
I/myorganisationagree/stoadministerthegrantthatmaybeofferedto theapplicantontheirbehalfandthat the informationstatedinthe‘auspicedapplication’sectionofthisapplicationistrueandcorrect.
Signature Date:
Nameinfull
Role(if relevant)
CERTIFICATION / I,theundersigned,certifythat:
I havereadandwillabideby theCHRC RADFGrantGuidelinesdocument
Thestatementsin thisapplicationaretrueandcorrectto thebestofmyknowledge,informationandbelief andthe supportingmaterialismyownworkortheworkof theartistsnamedin thisapplication.
I havereadandunderstoodtheInformationPrivacyandRightto InformationStatementandagreetothe useanddisclosureofinformationas outlinedin theStatement.
Signature
Ifyouareunder theageof18yourlegalguardian Date:
mustalsosignthisapplication

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website:

Nameinfull
Position(if applicable)
Signatureof Guardian Date:
Nameinfull
INFORMATIONPRIVACYANDRIGHTTOINFORMATION
Theinformationyouprovideinyourgrantapplicationwill beusedbytheRADFCommitteeandCentral Highlands Regional Counciltoprocessand assessyourapplicationand,ifsuccessful,to process,payandadministeryourgrant.Otherfundingagenciesidentifiedin yourapplication maybecontactedto verifygrantsrequested.
Ifyourapplicationissuccessful,thefollowinginformationmaybedisclosedto Arts Queensland:
the informationyouprovideinyourgrantapplication the amountoffundingyoureceive
the informationyouprovideinyouroutcomereportand textandimagesrelatedto yourfundedactivity.
TheInformationmaybe usedbyCentral Highlands Regional CouncilorArts Queenslandforreportingpurposes,training,systemstestingandprocess improvement.TheInformationmaybemadeanonymousandusedforstatisticalpurposes.ItmayalsobeusedinthepromotionofRADF orthepromotionoffundingoutcomesforarts andculturaldevelopmentin Queensland.Forthispurpose,theInformationandyourcontact detailsmaybeprovidedtoQueenslandGovernmentMembersof Parliament,themediaandotheragencieswhomaycontactyoudirectly. Central Highlands Regional CouncilandArts QueenslandmayalsopublishtheInformationin their AnnualReportsorontheirwebsites.
Central Highlands Regional CouncilandArts QueenslandtreatallpersonalinformationinaccordancewiththeInformationPrivacyAct2009.The provisionsof theRighttoInformationAct2009applytodocumentsin thepossessionof Central Highlands Regional CouncilorArts Queensland.
QUALITY, REACH, IMPACT AND VIABILITY 20%
QUALITY /

Produces or contributes to high quality arts and cultural initiatives for local communities.
Capacity to efficiently support and deliver arts and cultural services.

REACH /

Provides access to and engagement in arts and culture for diverse communities,practitioners, participants and audiences.
Evidence of local demand for proposed activities.
Contributes to addressing our local arts and cultural priorities.

IMPACT /

Demonstrates cultural, artistic, social or economic returns on investment.
Addresses the QLD Government Objectives for the Community.

VIABILITY /

Evidence of good planning and management of the project.
Leverages additional investment and/or sources of income.
Evidence of partnerships.

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website:

APPLICATIONCHECKLIST
IhavediscussedmyactivitywiththeRADFLiaisonOfficer(RLO)
Ihavereadandunderstoodthe CHRC RADF Grant Guidelines document
Allsectionsof theApplicationFormhavebeencompletedandtheapplicationis signedanddated
Ihavecheckedthebudgetandconfirmitbalances
ESSENTIALSUPPORTMATERIALEssentialitemsMUSTbeincluded fortheapplicationtobeeligible
ForEACHartsworkerreceivingwages:
1pageresume/CVorCompletedArtistEligibilityChecklist
Confirmationof availabilityincludingscheduleof fees/quote
Quotes/calculationsforeachiteminbudgetusingRADFFunds
CompletedCapitalExpenditureChecklist(Only forprojectsinvolvingcapitalexpenditureorpermanent structures suchasapublicartpiece)
2- 4lettersof supportillustratingcommunitydemand/supportforproject
RECOMMENDEDSUPPORTMATERIAL-Recommendeditems will strengthenyourapplication
Supportmaterialconfirmingbookings,venueavailabilityetc. Quotes,calculationsetc.supportingadditionalbudgetfigures
Supportmaterialconfirminganydonations,sponsorship,partnerships,approvedgrantsetc.
Evidenceof support/confirmationfromtargetgroupsof involvementin project(ONLYifprojectis targetedtowardscertain groupsasindicatedonpage5of application)

Central Highlands RegionalShireCouncil, POBox21,65 Egerton Street,EmeraldQLD4720

Ph1300 242 686•Fax1300 242 687 Email: ●Website: