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.

Name:
Title First name Surname
Position:
Name of organisation:
Name of funded activity:
Date of funded activity:
Phone: / Business: / Home: / Mobile:
Email:
Signed / Date
Department of Territory Families
Page 1 of 6 /

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.

Income / Expenditure / Office of Women’s Policy General Grant
Please provide details of all income generated by the activity. / Please provide details of all expenditure related to the activity. / Please indicate the expenditure (GST exclusive) that was funded by the Office of Women’s Policy general grant. Where a percentage of the expenditure was funded by the grant, please indicate the percentage and actual amount.
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
$ / $ / $
Total income / $ / Total expenditure / $ / Total OWP General Grant
funding expended (GST exclusive) / $

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: _____/_____/______

Department ofTerritory Families Page 1 of 6

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.

Estimated target / Actual attendance
Girls (up to 12 years old)
Boys (up to 12 years old)
Young women (12 to 25 years old)
Young men (12 to 25 years old)
Women who identify as non-Indigenous
Men who identify as non-Indigenous
Women who identify as Indigenous
Men who identify as Indigenous
Women from culturally/linguistically diverse backgrounds
Men from culturally/linguistically diverse backgrounds
Senior women (over 60 years old)
Senior men (over 60 years old)
Women who identify with disabilities
Men who identify with disabilities
Other (specify)
Other (specify)

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: ______

______

______

______

______

______

______

______

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

______

______

______

______

______

______

______

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

______

______

______

______

______

______

______

______

______

______

Who mostly benefited from the activity?

______

______

______

______

______

______

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

______

______

______

______

______

______

______

______

What would you do differently if you had the opportunity?

______

______

______

______

______

______

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

______

______

______

______

______

______

______

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

a)Promotes women’s safety:

______

______

______

______

______

______

b)Promotes women’s health and wellbeing:

______

______

______

______

______

______

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

______

______

______

______

______

______

d)Promotes women’s economic security:

______

______

______

______

______

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)

Department ofTerritory Families Page 1 of 6