SMALL GRANTS for RURAL Communitiesapplication Form: Round 31

SMALL GRANTS FOR RURAL COMMUNITIESApplication Form: Round 31

Open Tuesday 13 December to 5pm Friday 31 March 2017

For projects July 2017 – June 2018

ORGANISATION INFORMATION

Organisation Name
As appears on your ABN / Inc. Certificate
Postal Address / Town / State / Postcode
Website/s / Social media addresses
Facebook / Twitter/ etc.
ABN / Incorporation Number
Don’t know? Go to www.abr.business.gov.au / You MUST attach a copy of certificate
or print out of registration
GST – Registered / Yes / No
DGR – Deductible Gift Recipient / Yes / No / Provide a copy of ATO Endorsement if applicable
TCC – Tax Concession Charity / Yes / No / Provide a copy of ATO Endorsement if applicable
Head of Organisation This person MUST sign the last page or application willnot be considered. e.g. CEO, President, Chair
Mr Ms OtherName
Position Held / Phone No.
Email / Mobile
Second Contact for ApplicationPlease provide a second contact person, with separate contact details, who is familiar with the application
Mr Ms OtherName
Position Held / Phone No.
Email / Mobile

PROJECT INFORMATION

Project Title
Make it catchy!
Project Summary
Describe the project & its main outcome/s
(50 words max).
Grant Amount Requested
Maximum $5,000, use whole $ only / Population
Project location
Town Name
Project location / State
Project location / Post Code
Project location
Local Government Area
Project location
Proximity to nearest Capital City
Project location (e.g. 1450 km NE Perth, WA)
Impact area Choose ONE only
Sustainable Economies Strong Community Social Capital Local Infrastructure Equitable Service Access
Leadership and Skills Capacity of Individuals & Organisations Quality Services for Wellbeing
Category which best describes your projectPlease indicate one only
Culture / Economic / Education / Environment / Social Welfare / Health
Category which best describes the project’s target audience Please indicate up to three only
All Community / Adults / Older People (60+) / Families / Disabled & Carers
Children & Young Adults (0-25yrs) / Early Childhood
(0-5yrs) / Children
(6-13yrs) / Youth
(13-17yrs) / Young Adults
(18-25yrs)
Indigenous Australians / CALD / Men / Women / LGBTQIA
Does this project involve working directly with children/youth under 18? Please indicate one only / Yes / No
Does your organisation have policies and procedures regarding working with children, Working with Children Checks, and the handling of child abuse complaints?Please indicate one only / Yes / No
PROJECT DETAILS
DESCRIBE THE MAIN FEATURES OF YOUR COMMUNITY
What are the main features? What are the local resources, assets and strengths? What else can you tell us about your community? i.e. demographics, diversity, employment opportunities, community plans/ activities/ networks/ organisations, events, educational opportunities, etc.
TELL US ABOUT YOUR ORGANISATION
Provide a brief overview e.g. mission, founding date, programs / distinctive attributes, number of people involved i.e., enrolments, staff, volunteers, engagement with other groups etc. For halls, detail use of facilities e.g. user groups, attendees, hrs use per week/month, etc. Outline the organisational and community capacity you have to complete the project and how it will be managed.
WHAT WOULD YOU LIKE THE GRANT FOR?
Please describe the project NB: Purely sporting or social projects are not charitable and are not eligible.
What is the need in the community?
What you will actually do – what are the project’s aims, objectives, timeframes?
What are the expected outcomes?
How will the project benefit the community?
WHO SUPPORTS THIS PROJECT?List other organisations that are supporting this project and attach signed supporting letters.
NB: If application is regarding property owned by a third party a letter of consent/support must be attached (e.g.: halls owned by local government)
Who will be involved?
What will they be doing?
Are they contributing to the project with cash and/or in-kind support?
WHEN WILL THE PROJECT HAPPEN?
Please provide a Project Plan outlining the expected dates that this project will become operational and completed, including project milestones. Attach a separate page if required. If you need help with this, see our planning tool at
NB: You will not receive funds until end of July 2017 and FRRR cannot fund retrospectively.
HOW WILL YOU KNOW THE PROJECT HAS MADE A DIFFERENCE IN YOUR COMMUNITY?HOW WILL YOU MEASURE SUCCESS?
How will you know the project is successful? What will occur if the project is successful that doesn’t occur now? How will you measure that you attained the outcome that your group is seeking? Please provide measurable numbers e.g. train25 people, reach 60 families.How will you communicate the success and learning of this project and who will you sharing it with?
IF RELEVANT, WHAT STRATEGY DO YOU HAVE IN PLACE TO ENSURE OUTCOMES ARE SUSTAINABLE LONG-TERM?
What’s your group’s strategy to financially sustain the project in the medium to long-term?

PROJECT FINANCES

DOES THE FRRR GRANT AMOUNT REQUESTED COVER THE FULL PROJECT COST? YES NO

PLEASE COMPLETETHE BUDGET TABLE BELOW FOR YOUR PROJECT

PROJECT BUDGET(use whole $ only)
CASH INCOME / $ / CASH EXPENDITURE / $
FRRR Grant Request(as per requested $ on page 1)
Cash contribution from your organisation
IN-KIND SUPPORT – WHO
(must balance in-kind expenditure) / $ / IN-KIND SUPPORT - WHAT
(must balance in-kind income) / $
In-kind contribution from your organisation
TOTAL(must balance total expenditure) / TOTAL(must balance total income)

If you are unsure about how to complete this budget, please ring 1800 170 020 to discuss.

TELL US ABOUT YOUR ORGANISATION’S FINANCIAL CAPACITY

Has your organisation previously received and acquitted a grant before? / Yes / No
What was your total annual turn-over last financial year?Round to the closest whole dollar / $
ATTACH ONE OF:Indicate ONE only / Audited statements for the last financial year? / Yes Attached
A profit and loss statement for the last complete financial year AND a balance sheet at the FY end date / Yes Attached
If these show….Answer ONE only / PROFIT/ SURPLUS/
LARGE CASH RESERVES /

Is your surplus/cash reserves held for a project?

Are you fundraising for any other major projects?

OR
LOSS/ DEFICIT /

What is the reason why you have a loss / deficit?

Do you foresee this changing?

APPLICATION CHECKLIST CERTIFICATION
ENSURE YOU HAVE COMPLETED THESE SECTIONS
and answered all questions on the form in full /

Organisation Information
Project Information
Project Finances
Organisation Finances

/ YES
YES
YES
YES
ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material must be submitted with the application

OrganisationFinancials - either last audited statement OR current profit & loss/balance sheet (ESSENTIAL)
Certificate of ABN or Incorporation - or attach printout from www.abr.business.gov.au (ESSENTIAL)
Letters of support for project (very highly regarded)
Quotes to support budget items (very highly regarded)
Project Plan (OPTIONAL but highly regarded)
Certification (see below) signed by legal head of organisation (ESSENTIAL - may be submitted as a PDF attachment)

/ YES
YES
YES NO
YES NO
YES NO YES N/A
PLEASE COMPLETE THE BELOW CERTIFICATION - Must be signed by the Head of the Organisation or cannot be considered for funding
I/We acknowledge and understand that all applications become the property of FRRR.
I/We agree that FRRR may provide this application to other potential funding sources.
I/We agree to inform FRRR if the organisation has a significant change to its financial situation.
I/We agree if successful to expend any FRRR funding within 12 months.
I/We agree for FRRR to publish stories and photographs of grants funded.
HEAD OF ORGANISATIONMUST SIGN HERE or application will not be considered. e.g. Chair, CEO, President NOT Secretary,Treasurer etc.
NAME: / SIGNED:
POSITION: / DATED:
ORGANISATION NAME:
PLEASE SUBMIT YOUR APPLICATION, VIA EMAIL
or VIA POST,FRRR - Small Grants, PO Box 41, BENDIGO, VIC 3552.
Applications need to be clearly postmarked before or on the CLOSING DATE, 5pm Friday 31 March 2017
Note:EMAIL WORD DOCUMENTS ARE PREFERRED TO PDF FILES
Optional questions and
feedback on application process / On a scale of 1= Easy to 5= Hard, how would you rate this application?
Please estimate time taken to complete application in hours?