Sport and Recreation Grants Program – Application Form July 2017

Scenic Rim Regional Council

Sport and Recreation Grants Program

Application Form

Please return the original completed application form and selection criteria to:

The Chief Executive Officer

Scenic Rim Regional Council

PO Box 25, Beaudesert Qld 4285
OR

Organisation Details:

  1. Name of organisation:

Year established:
  1. Postal address:
  1. Street address: (where the equipment/project will be based)
  1. Contact person and position held in the organisation:
  1. Telephone andemail address:

Business hours phone: Mobile:
Email address:

6.ABN: Please provide

  1. Are you registered for GST?Yes □No □

If you do not have an ABN, please complete a Statement by a Supplier Form.

  1. Is your organisation a not for profit sport and recreation organisation?

Yes □No □

  1. Is your organisation incorporated?

Yes □

No □ The application must be sponsored by another incorporated organisation which accepts legal and financial responsibility for the grant. Please attach a copy of the sponsor organisation’s Certificate of Incorporation and letter agreeing to auspice the application

$
  1. Please advise your limit of public liability insurance.

Project:

  1. Brief project description: (as per eligible projects outlined in the guidelines):

$
  1. Grant amount requested:
  1. Have you previously received funding from the Scenic Rim Regional Council?

Yes □No □

If Yes:

Approximate date and amount of grant

Name of program:

14. Is the work to be carried out on Council land? Yes □

You must obtain Approval under the Community Project Works on Council Land Policy.

(Please contact Council's Property & Operations Department on 5540 5111 for more information)

No□

Please provide tenure details (eg lease agreement and name of lessor)

15. Budget Information and ability to deliver:

Item Description / Price / Cash / in-kind contribution / Supplier / Provider / Amount requested from Council

16. Agreement

I have read and agree to the Terms and Conditions set out in the guidelines. I certify that all the information provided is current and correct, and I give permission to Scenic Rim Regional Council to contact any persons or organisations in regards to the Sport and Recreation Grants Program process. I have read the privacy statement attached.

Signed for and on behalf of the organisation. Only the Chairperson, Secretary or President of the organisation which is to receive the grant should sign.

 Mr Mrs Ms Miss Other:

Print Name of President/Chairperson / Signature / Date

Please complete the attached Selection Criteria and read the privacy agreement

Scenic Rim Regional Council

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Sport and Recreation Grants Program – Selection Criteria

Selection Criteria:

  1. Overview of your organisation

Provide a brief overview of your organisation including:

(a)What your organisation does

(b)What competition your organisation competes in

(c)How many members your organisation has, please separate senior and junior if applicable for example 80 senior members and 95 junior members

(d)Number of teams if applicable

(e)Do you host competitions or tournaments

(f)How do you attract members

(g)Outline demonstrated financial and project management capacity, please provide an example of a past project your organisation has delivered within budget and on time

  1. Overview of your project (please attach any relevant support material)

Provide a brief description of your project including:

(a)An outline of your project including any perceived benefits the project will bring to the community or your organisation

(b)An outline of need and commitment to increase participation across all age groups

(c)Details explaining collaboration and partnerships with other community groups

(d)Describe how the project will achieve an objective in your organisation’s strategic plan or Council’s Sport and Recreation Plan 2010-2020 or associated strategic documents

  1. Acknowledging the grant

Tell us how you will publicly acknowledge the Sport and Recreation Grants Program funding (please refer to funding guidelines for acknowledgement requirements).

Scenic Rim Regional Council

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