/ Third Party Fundraising Event Application Form

This form must be completed and returned to the Eastern Health Foundation.

Please complete as much of this form as possible. Rather than leave a section incomplete, please state the reason why you consider the section irrelevant to your project.

Applicant information
Full Name
Address
Contact Details
Organisation
Department
Position
Contact phone number
Contact email
Brief Summary of Project / Event
Project Title / Event Name
Project Purpose
Date of the Event
Is the project specific to Eastern Health only?
If NO, please provide details of which other organisations are involved
What are the aims and objectives of the event?
Brief summary of project / event
Appropriate Activity for Eastern Health
What is the geographical reach of the project?
How does the project support the Eastern Health Foundation purpose?
Are partnerships of any kind being sought or currently in place with any other organisation or individual?
If YES, please provide details
Key people involved in the project / event
Project Manager / Event Manager
Organisation
Position
Contact phone number
Contact email
Provide details of other organisations and key people involved in the project / event
Are all project participants external to Eastern Health covered by their own insurance while conducting project / event activities?
  • Please provide details.

Does the project require Eastern Health Foundation staff to perform any function or activity?
  • Please provide details and the expected time involved.

What has motivated you to organise and host this event?

Compliance

Eastern Health has been endorsed as a Deductible Gift Recipient (DGR) by the Australian Taxation Office (ATO). The following information is required to ensure that all fundraising activity conducted for the benefit of Eastern Health meets the requirements of the relevant government agencies.

Funds raised
How will the funds raised be collected?
  • Please list all potential collection avenues

What is the estimated amount to be raised by this project / event?
Are the funds raised to be used for the benefit of Eastern Health and its objectives only?
Is there any restriction on the manner in which Eastern Health can use the funds raised?
Do you require Eastern Health Foundation to forward receipts to donors?
Communications
Will the Eastern Health Foundation logo be used in any aspect of this project?
How will the project be promoted?
What are the key messages of the project and how will these be communicated?
Insurances
The following information is required to ensure that appropriate insurances are in place to cover all people and activities involved in fundraising projects conducted by, or for the benefit of Eastern Health
What insurance cover have you put in place for the purposes of your project?
Who is responsible for ensuring all insurance requirements are met?

I have read and I agree to comply with the Eastern Health Foundation – Guidelines for Third Party Fundraising Organisers document:

Print full name:______

Print residential address:______

Contact telephone number:______

Signed:______Date:______

Approval (for Eastern Health Foundation use only)
Name and Title of Third Party Event approver
Name and Title of Delegated Authority
Date of decision
Not endorsed / Deferred / Endorsed (feasibility only) / Endorsed
Business Case Required / Yes No 