Women General Grant Acquittal Form

Office of Women’s Policy

GeneralGrants Acquittal Form

Please complete this financial report template or present a financial report in your own format, detailing the income and expenditure for the activity funded by the general grant.

The expenditure should match the budget breakdown from your application form. If there are items included that were not specified in your application form, please provide reasoning. Ensure to include receipts, photos and any other supporting documentation.

Please contact the Office of Women’s Policy in writing to advise if there are unspent funds (GST exclusive) from the International Women’s Day grant funds.

Please forward the completed acquittal form to the Office of Women’s Policy by any of the following means, ensuring the form is received by the Office of Women’s Policy within six weeks of the date the funded activity occurred:

Post to: PO Box 40596, Casuarina NT 0881

Deliver to: 2nd Floor RCG House, 83-85 Smith Street, Darwin

Email to:

By submitting an acquittal form by email, you acknowledge that you are duly authorised to submit an acquittal on your own behalf or on behalf of the organisation that received the grant.

All acquittal forms must be signed by two office bearers of the administering body. Acquittal forms will only be accepted by email if they are signed and the signed copy is scanned.

DECLARATION

(To be completed by the person submitting this acquittal form)

• I declare that the information I have provided in this form is complete and correct and the organisation that I represent supports this acquittal.

Financial report

Note: All income and expenditure related to the funded activity must be included. Where variations to the original budget have occurred, comments are required on the actual expenses incurred.Please attach a financial report in your own format as separate page, if required.

I certify that the grant was used for the approved purpose and that the financial report for the grant is true and correct.

Print name: ______Print name: ______

Official Office Bearer of Administering Body Official Office Bearer of Administering Body

(If an individual, only one signature is required)

Signature: ______Date: _____/_____/______Signature: ______Date: _____/_____/______

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Statistics of the event or activity

To assist the Office of Women’s Policy to identify the demographics of participants in your event or activity, please complete the table below.

Was the Northern Territory Government logo used in the promotion/advertising of the activity?

YesNo

Did your activity meet your objectives?

YesNo

Details and evidence to support this: ______

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Describe the activity that was actually carried out. Did the activity have any changes from your original application form?

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What were the successes and challenges? How did you evaluate the success?

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Who mostly benefited from the activity?

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Have you spent the grant funds according to your application form? If not, please provide reason.

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What would you do differently if you had the opportunity?

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Are you happy with the general grant experience that the Office of Women’s Policy provided and is there anything we could do better?

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Please provide a summary of your event/activity. How did it meet one or more of the following criteria:

a)Promotes women’s safety:

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b)Promotes women’s health and wellbeing:

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c)Encourages women to aspire to leadership roles, increases women in decision making or participation:

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d)Promotes women’s economic security:

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Applicants Checklist

Please use this checklist to ensure you have included all necessary documentation and ensure to keep a copy of the entire acquittal report for your records.

Completed each section of acquittal form with extensive detail

Financial report in your own format attached (if required)

Photos, receipts and any other supporting evidence attached

Letter or email of unspent grant funds sent to OWP (if required)

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