Wentworth & District Community Bank

2014 Sponsorship Application Page 1

2014Sponsorship Application

Closing date: Thursday 16 April 2014

Important information for application completion:

Only typed applications will be accepted.
All applications must contain at least one, and preferably two, formal quotes for each budgetted item to be purchased or work to be completed by outside agencies.
A copy of your Organisation’s current Business Plan must be included if your application exceeds $20,000.
A copy of your most recent Annual Report (2013), including Financial Statements and Auditor’s Report,must be attached.
Attach any letters of support, plans etc. which you believe will assist us in evaluating your application for funding and any additional information that you believe may be relevant.

If your application for funding is successful, you will be required to:

Make an appropriate public acknowledgement of the funding source / sources for the project.

Complete an Evaluation Form at the end of the project and return it to the Bank.

This application will be considered in accordance with the Bank’s Community Support Policy with particular reference to the Board’s discretion on the allocation of funds and the consideration of each submission on its merits.

Please contact Jill Davidson 03 50273518 or Daryl Wescombe03 50273362 if you have any queries regarding the full completion of this Application Form.

Name of Organisation:

……………………………………………………………………………………………………….

Project Title:

……………………………………………………………………………………………………….

Postal Address:

……………………………………………………………......

Contact Persons:

Name:……………………………… Position……………….Phone……………………………

Fax:……………………Email:…………………………….………......

ABN: ………………………………………………………………………………………………..

Are you a Deductible Gift Recipient or Registered Charity? YES / NO

If yes, please provide copy of current certification.

Are you registered for GST? YES / NO

(If yes, we will require you to provide us with a Tax Invoice, should your application be successful)

Is your Organisation a customer of the Wentworth & DistrictCommunity Bank® Branch Bendigo Bank? YES / NO

If yes, approximate number:- ……………

………………………………………………………………………………

Signature of Chairperson / Treasurer / or Management Representative

Sponsorship information

Dollar Value of Funding sought: $......

What does your organisation do? (Please provide information on mission statement, founding date, major programs, attributes, number of members, staff and/or volunteers.)

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Please fully outline how your organisation, committee and/or members have supported the Wentworth & District Community Bank® Branch.

Please fully outline your proposed event or project, including location. (What particular need will it meet, who will benefit, numbers, etc?)

Please advise how many people in the community this proposed project/venture/facility will affect/assist

Please detail fundraising efforts and/or contribution to be made by your organisation towards the event/project?Other Sponsoringorganisations? (Fundraising events, government funding sought, other stakeholders in the project, etc.)

…………………………………………………………………………………………………

How will your organisation manage this event/project? (e.g.Outside contractor, through Council, self managed.)

What date and time is your event/projectscheduled to occur?

......

Is the proposed sponsorship expenditure to be applied outside of the Wentworth Shire? If yes, what proven benefits will be available to Wentworth Shire residents?

……………………………………………………………………………...... ………………………………………………………………………..….….....………………………………….………………………………………...……...………………………………………………………………………...………...……………………………………………………………………...…………...…………………………………………………………………...……………...………………………………………………………………...………………...……………………………………………………………………………………………………………….

Has your Organisation previously received Wentworth & DistrictCommunity Bank® Branch Bendigo Bank funding?

If so, please complete details below.

Year / Project Title / Funding Received $ / Evaluation Form returned Y/N

Please outline what promotional opportunities or return business your Group will provide Wentworth & District Community Bank® Branch in return for Sponsorship funds requested? (Such as signage, media coverage or exposure, brochures, advertising, additional banking business etc.)

2014 Sponsorship Application Page 1

11. Please complete the table below to fully outline where project funding will come from, and how they are budgetted to be expended.Refer Attachment 1 for example.

Budgeted Item / Community Bank® Funding Sought / Your Organisation’s Contribution / Third Party Contribution / Total Cost
Direct / In-kind / Direct / In-kind
TOTAL

Please provide notes below to fully clarify above table.

12.Is the Community Bank funding catalytic to the project going ahead? YES / NO

Self explanatory

13.Please identify the Economic Outcomes by placing a tick next to the relevant economic impact indicator below:-

ECONOMIC OUTCOMES / Impactsresultingfromtheinvestmentthatcontributetoeconomicoutcomesforthelocalcommunity.
Usagevalue

/ Thelevelofusagebythecommunityoftheprojectinwhichtheinvestmentwasmade,relativetoexpectations.
Morethanexpected / Theinvestmentisusedmuchmorethanexpected
Asexpected / Theinvestmentisusedmoreorlessasexpected
Lessthanexpected / Theinvestmentisusedmuchlessthanexpected
Unknown / Theprojecthasnotbeencompleted,henceactualusageisunknown
Localinputs

/ Thisprovidesanassessmentoftheextenttowhichrecipientsareabletopurchasetheirsupplieslocally.BoththesuppliesassociatedwiththefundingreceivedfromtheWentworth & DistrictCommunityBank®branchaswellasamoregeneralassessmentoftheorganisation’sprocurementprocess.
Alllocalinputs / Allsuppliesarepurchasedlocally(estimatedasapproximately100%ofsupplies)
Mostlylocalinputs / Mostsuppliesarepurchasedlocally(estimatedasapproximately66%ofsupplies)
Somelocalinputs / Somesuppliesarepurchasedlocally(estimatedasapproximately33%ofsupplies)
Nolocalinputs / Nosuppliesarepurchasedlocally(estimatedas0%ofsupplies).
Significantfurthereconomic outcomes
Yes

No / Thisisayes/noresponsetowhethertheinvestmentisconsideredtohavesignificantfurthereconomicoutcomes.Theresponsewillbeyesonlyiftheinvestmentisconsideredcritical tothecommunity inawaythat cannotbecaptured bythemorestandard economicimpactassessmenttools(aspertheusagevalueandflow-oneconomicstimulus),becauseitisfundamentaltothecommunity’sprosperity.Examplesheremayincludeschools,hospitals,orevenimportantsportingclubsorhospitalityvenues,wherethesearefacilitiesthatprovidethecorefoundationforwhypeopleliveinthetown.Suchafacilitycouldbeconsideredcoreifwhenitceasedtoexist,itcouldreasonablybeexpectedthatotherbusinessandpopulationswouldmoveawayfromthecommunity.Itisexpectedthiswillonlybethecaseinexceptionalcases.
NON-ECONOMICOUTCOMES / Impactsresultingfromtheinvestmentthatarenotdirectlyrelatedtoeconomicactivityandthereforecannotbequantifiedindollarterms.
Personsaffected/$spent

/ Thisiscalculatedautomaticallyonthebasisofexpenditureandnumberofpersonsaffected.Itindicatesthereachofeachdollarspent,intermsofthenumberofpeoplewhobenefit.
High / Relativetootherinvestments,alargenumberofpeopleareaffectedperdollarspent.
Medium / Relative to otherinvestments,anaverage numberof peopleare affectedperdollarspent.
Low / Relativetootherinvestments,alownumberofpeopleareaffectedperdollarspent.
Scaleofaverageimpactperperson

/ Averageoutcomeacrossallpeopleaffected,notspecifictoindividuals/minority
Significant / Thisiscanbereasonablydemonstratedtobeasignificantimpactoftheinvestmentperpersonaffected.
Minor / Thisiscanbereasonablydemonstratedtobeaminorimpactoftheinvestmentperpersonaffected.
None / Thereisnoevidenceofaresultingimpactforthisoutcomeinassociationwith theinvestment.

14.Please identify the following Social Impacts which the project/event/facility would provide by indicating the choice of wording” None / Limited / Moderate / High” next to each outcome:-

Socialimpacts

/ Human and social capital outcomes
Pridein community / Occurswhenaninvestmenthelpstofosteralevelofsatisfactionamongcommunitymembersasaresultofimprovingtheperceivedstatusoftheircommunity,from the point of view of both communitymembers andexternalvisitorstothetown.
Participation / Occurswhencommunitymembersareprovided withtheopportunitytobecomeinvolvedinacommunitygroup,activityorevent.Thelevelofparticipationmayrangefromanongoingandregularcommitmenttoaone-offorannualinstance.
Volunteerism / Occursifthe investment attractscommunitymembers toofferin-kindlabour tocommunityorganisationsorevents.Volunteeringtakesmanyformsandmaybeperformedbyawiderangeofpeople.Volunteerscanbespecificallytrainedintheareastheyworkin;othervolunteersserveonanas-neededbasis.
Humancapital / Occurswhenaninvestmentbuildstheskillsand/orknowledgeofthosedirectly affected.Skillsand/orknowledge canbedevelopedvia avarietyofdifferentchannels–thiscanrangefromformaltrainingthroughtolifeskillscoachingsessions.
Wellbeing / Capturesanyimprovementtothequalityoflifeforpersonsdirectlyaffectedbytheinvestment.Thisincludesimprovementstophysicalhealthand/ormentalhealth.
Personalsafety / Improvesthephysicalsafetyofthepersonsaffectedbytheinvestment.Thiscantaketheformofanyimprovementsorassetsthatreduceexposureorrisktoharm,accidentoranyeventthatcouldbecategorisedascausingphysicaldamagetoindividuals.
Networking
-withinorganisations / Networking–withinorganisationsiswhereaninvestmentassistsanorganisationtoimproveitsinternalgovernance,coordinationandinternalrelationships.
Networking
-betweenorganisations / Networking–betweenorganisationsiswhereaninvestmentassists anorganisation to buildlinks and relationshipwith members andother
groupsinthecommunity.Thissocialoutcomeisimportantforcapturinginvestmentsthatfacilitateconnectionswithincommunities.

15.Please identify the following Environmental Impacts which the project/event/facility would provide by indicating the choice of wording” None / Limited / Moderate / High” next to each impact:-

Impactsonthenaturalorphysicalassetsofthecommunityanditsbroaderenvironment.
Urbanamenity / The provisionoffacilitiesand/orimprovement madetotheurbanlandscape.Itcanincludetheconstructionofanasset,improvementstotheaestheticsofurbanspaces,orprotectionofman-madeheritageassets.
Naturalamenity / The provision offacilities and/orimprovement madeto thenaturallandscape.Thiswilltypicallyincludeanyimprovementstotheaesthetics(i.e.naturalbeauty)ofthecommunity’snaturalenvironment(e.g.treeplantings)andprotectionofnaturalassets.
Sustainability / Anyactionsor productsthat reduceconsumption ofnon-renewableresources,suchasenergyandwater.

Environmental impacts

Community Development Funding Application

Attachment 1:

EXAMPLE ONLY:

Wentworth District Childcare Centre $610,000

Budgeted Item / Community Bank® Funding Sought / Your Organisation’s Contribution / Third Party Contribution / Total Cost
Direct / In-kind / Direct / In-kind
Feasibility, Plans & Permits / $20,000 / $20,000
Site Preparation / $25,000 / $25,000
Construction / $15,000 / $335,000 / $350,000
Fit Out / $15,000 / $100,000 / $115,000
Land / $100,000 / $100,000
TOTAL / $20,000 / $15,000 / $15,000 / $435,000 / $125,000 / $610,000

Please provide notes below to fully clarify above table.

Site preparation $25,000 in kind labour donation from local Dig Deep earthmoving contractors – Quote attached.
Construction funding sourced from Kevin ’07 Ready Grants Program $335,000 – approval letter attached. Additional $15,000 by volunteer labour for painting & decorating – Estimations of dollar value attached.
Community fundraising efforts $15,000 towards fit out – Copy of Bank statement attached.
Wentworth Shire Council – Land donation $100,000 – Copy of Shire undertaking attached.