Community Planning

SEED Funding Application Form

Name of Community Plan:______

Community plan Start Date: ______End Date:______

Project Summary

Project 1: ______Cost: ______

Project 2:______Cost: ______

Project 3: ______Cost: ______

Total $: ______

NOTE: The maximum SEED Funding amount is $7,500 in total per 3 year Community Plan, paid in one lump sum. You can only apply once per Community Plan. E.g. if you apply for $2,000 now, you can not apply for a further $5,500 at a later stage during the same plan. Variation to this application can be applied for if changes need to be made.

CONTACT PERSON FOR THIS APPLICATION

Name: ______

Position Held:______

Postal Address: ______

______

Daytime Phone Number:______Email: ______

  1. PROJECT DETAILS

Complete the following section for each project that will be undertaken with the SEED funding.

Project 1

Name of the project: ______

Brief description of the project:

______

______

______

______

______

Which area of the community does this project aim to improve?

Health & Well-being (Including Social and participation)

Economic

Environment

Arts & Culture

Infrastructure

Other – Please specify______

Who in the community will benefit from this project? How they will benefit?

______

______

______

______

______

Where will the project take place? (Project location and address)

  • ______
  • ______

Please list key groups or individuals that will be involved in implementing this project? Please note the person who applies for this SEED funding will be Council’s contact person for ALL projects.

  • ______
  • ______
  • ______
  • ______
  • ...... ______

Project 2

Name of the project: ______

Brief description of the project:

______

______

______

______

______

Which area of the community does this project aim to improve?

Health & Well-being (Including Social and participation)

Economic

Environment

Arts & Culture

Infrastructure

Other – Please specify______

Who in the community will benefit from this project? How they will benefit?

______

______

______

______

______

Where will the project take place? (Project location and address)

  • ______
  • ______

Please list key groups or individuals that will be involved in implementing this project? Please note the person who applies for this SEED funding will be Council’s contact person for ALL projects.

  • ______
  • ______
  • ______
  • ______

Project 3

Name of the project: ______

Brief description of the project:

______

______

______

______

Which area of the community does this project aim to improve?

Health & Well-being (Including Social and participation)

Economic

Environment

Arts & Culture

Infrastructure

Other – Please specify______

Who in the community will benefit from this project? How they will benefit?

______

______

______

______

______

Where will the project take place? (Project location and address)

  • ______
  • ______

Please list key groups or individuals that will be involved in implementing this project? Please note the person who applies for this SEED funding will be Council’s contact person for ALL projects.

  • ______
  • ______
  • ______
  • ______

If you have more than 3 projects please complete the same information for additional projects.

PROJECT TIMELINE

Please provide approximate timing for the project implementation

Project Name / Commencement Date / Completion Date
Project 1
Project 2
Project 3

ELIGABILITY CHECKLIST

Are all projects listed above included in your current Community Plan? YES / NO

If no please explain, ______

Community Consultation

How many people were consulted for the current community plan? ______

What methods were used for consultation? E.g. survey, public meeting ______

______

______

______

How many community members were involved in prioritizing these projects for SEED funding?______

Have the Community Coordinators advertised the SEED funding application and priority projects to the broader community? YES / NO

If yes, what methods were used?______

Please note that on approval the applicant will be required to sign a Funding Agreement which has the full list of regulations required.

BUDGET

Please summarise the expenditure for each of the projects.

Project Number / Expense Items (Paid for from SEED Funding) / Cost
1 / $
$
$
Total Project Cost
2 / $
$
$
Total Project Cost
3 / $
$
$
Total Project Cost
GRAND TOTAL / $

Please list any in-kind contributions that individuals, groups or organizations will provide to deliver these projects.

In–kind Contribution

Project # / Description of Services or Products / Value of Services ($) / TOTAL
$
$
$
$
Total In-kind / $

AUSPICE ORGANISATION DETAILS (If your group is not incorporated the money must be held by an auspice organization. If you are incorporated an auspice organization is not required)

Name of the Auspice Organisation: ______

Is this organisation (Please circle YES or NO)

  • Non-profit, community managed?YES / NO
  • Incorporated or managed as a Council or Crown Committee? YES / NO

Will this organisation be managing the project? YES / NO

If “NO” please provide details of the organisation who will manage the project.

______

______

Is the management organisation for this Project registered for GST? YES / NO

Australian Business Number of the organisation (ABN): ______

DECLARATION BY APPLICANT

I declare that the above details are correct and I am signing on behalf of my local community to apply for the Golden Plains Shire Council SEED Funding.

Signature: ______

Name: ______

Position: ______

Phone Number: ______

Email: ______

Date: ______

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