2015 Application Formfrrr Abc Heywire

2015 APPLICATION FORM FRRR ABC HEYWIRE YOUTH INNOVATION GRANTS

Please read the guidelines before completing your application. Applications close 5pm, Friday 12 June 2015. If possible, please save as a word document & submit via email. Enquiries can be made to FRRR on freecall 1800 170 020 or [email protected] See www.frrr.org.au for more information on applying, grantseeker FAQ’s and application top tips! 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 You MUST attach a copy of certificate Don’t know? Go to www.abr.business.gov.au 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 will not be considered. e.g. CEO, President, Chair Mr Ms Name

Position Held Phone No Email Mobile

Second Contact for Application Please provide a second contact person, with separate contact details, who is familiar with the application Mr Ms Name

Position Held Phone No Email Mobile PROJECT INFORMATION 2015 Heywire idea your community is adopting Please indicate one only The Race Don’t Need Drinks to Dance Raise Your Cards Hands up! Ag Gap Gen Aware Break the Chain Boots for Change Town Name State Post Code Project location Project location Project location Population Local Government Area Project location Project location Proximity to nearest Capital City Project location (e.g. 1450 Kms NE Perth, WA) 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 Early Childhood Children Youth Young Adults (0-25yrs) (0-5yrs) (6-13yrs) (13-17yrs) (18-25yrs) Indigenous Australians CALD Men Women GLBT Does your organisation have policies and procedures regarding working with children and the handling of Yes No child abuse complaints? Please indicate one only WHO SUPPORTS THIS PROJECT? Are there project partners? Is the project community driven and can you show wider community support? List and attach letters. If your application is regarding property owned by a third party a letter of consent/support must be attached eg: halls owned by Local Government.

WHEN WILL THE PROJECT HAPPEN? Please outline the expected dates that this project will commence and be completed by, and highlight any project milestones. NB: You will not receive funds until end August 2015 and FRRR cannot fund retrospectively. TELL US ABOUT YOUR COMMUNITY What are the main features? Detail strengths/weaknesses and issues/needs which are relevant to this proposal. What can you tell us about youth in your community? i.e. demographics, diversity employment, community plans/ activities/ networks/ organisations, , recent natural disasters etc. Why does your community need this opportunity?

WHAT DOES YOUR ORGANISATION DO? Provide a brief overview e.g. mission, founding date, programs/distinctive attributes, number of members, enrolments, staff, volunteers, engagement with other groups etc. 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. If you are already doing something similar, please let us know how it differs from the idea you wish to adopt and implement.

WHAT WILL YOU DO - HOW WILL YOU IMPLEMENT THE HEYWIRE IDEA IN YOUR COMMUNITY? Please describe the project plan in as much detail as possible – you can do this in descriptive paragraphs and/or use the table template. (Try to tell us EXACTLY what you will do to make the Heywire idea come to life ). Will there be youth involvement in the project’s planning, outreach, implementation and evaluation? How will you engage with youth? DESCRIPTION:

PROJECT IMPLEMENTATION PLAN (Optional template – insert more rows if required) OUTCOME TASK (WHAT) HOW WHO TIMELINES RESOURCES MEASURES (KPIs) Advertise opportunity Community e.g. Establish youth Communications Team Youth committee active on social media, in and Development Officer / September2015 advisory committee Briefing/welcome pack with 10+ members clubs / school assembly School welfare worker PLEASE STATE THE PROJECT’S OUTCOMES & HOW THE PROJECT WILL BENEFIT YOUR COMMUNITY? What exact OUTCOMES will be achieved? Who will benefit? How will implementing the idea will make a difference to your community, and what ONGOING CHANGES do you think will result?

HOW WILL YOU MEASURE AND COMMUNICATE SUCCESS? How will you know the project is successful? How will you undertake project evaluation and/or outcomes measurement? Have you planned project outreach? Describe strategies. If possible, provide measurable numbers e.g. train 25 people, reach 60 families, 3 news stories, reach 700 likes on Facebook.

WILL THE SUCCESS OF THE HEYWIRE PROJECT BE SUSTAINED BEYOND THE GRANT? Do you see opportunities for scaling the project? How would you achieve this?

PROJECT FINANCES DOES THE FRRR GRANT AMOUNT REQUESTED COVER THE FULL PROJECT COST? YES NO PLEASE COMPLETE THE BUDGET TABLE BELOW Include all other contributions. Are these confirmed or pending? Provide quotes for costs and attach. Include a description of in-kind support in your budget, both WHO and WHAT they are contributing, e.g. discounts on quotes, waived hire, catering, project co- ordination, sponsorship etc. In-kind support is VERY highly regarded. Total income must equal total expenses. PROJECT BUDGET (This table must be completed. Use whole $ only & insert more rows if required) CASH INCOME $ CASH EXPENDITURE $

FRRR Grant Request (as per requested $ on page 1)

Cash contribution from your organisation

IN KIND SUPPORT - WHO IN KIND SUPPORT - WHAT Itemise the non-cash support for the project. $ List & cost goods or services donated. Detail or breakdown $ Who is helping and to what value how this group/person’s support e.g. 4 hours x $25 /10% off In-kind contribution from your organisation

TOTAL INCOME TOTAL EXPENSES

DO YOU HAVE ANY NOTES OR COMMENTS REGARDING THE PROJECT BUDGET OR IN-KIND SUPPORT? Answer optional. 2015 FRRR ABC HEYWIRE YOUTH INNOVATION GRANTS APPLICATION CHECKLIST & CERTIFICATION  Organisation Information YES ENSURE YOU HAVE COMPLETED THESE SECTIONS  Project Information YES and answered all questions on the form in full  Project Finances YES ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material must be submitted with the application  Organisation Financials - either last audited statement OR current profit & loss/balance sheet (ESSENTIAL) YES  Certificate of ABN or Incorporation - or attach printout from www.abr.buisness.gov.au (ESSENTIAL) YES  Letters of support for project (OPTIONAL, but very highly regarded) YES NO  Quotes to support budget items (OPTIONAL, but very highly regarded) YES NO  Project Plan (OPTIONAL if submitting as a separate attachment) YES N/A  Certification (see below) signed by legal head of organisation (may be submitted as a separate attachment) YES N/A PLEASE COMPLETE THE BELOW CERTIFICATION - Must be signed by the legal head of your organisation or application ineligible 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 and ABC to publish stories and photographs of grants funded HEAD OF ORGANISATION MUST SIGN HERE or application will not be considered. e.g. Chair, CEO, President NOT Secretary Treasurer etc. (This page can be printed, signed, scanned or photographed and attached separately to the application if electronic signature unavailable) PRINT NAME SIGNED

POSITION DATED

ORGANISATION NAME PLEASE SUBMIT YOUR APPLICATION VIA EMAIL to [email protected] OR VIA POST FRRR ABC Heywire Youth Innovation, PO Box 41, BENDIGO, VIC 3552. Applications need to be clearly postmarked before or on the CLOSING DATE, 5pm Friday 12 June 2015 Note: EMAIL SUBMISSIONS & WORD DOCUMENTS ARE PREFERRED TO PDF FILES OPTIONAL On a scale of 1= Easy to 5= Hard how would you rate this application? Feedback on application process Please estimate time taken to complete application in hours? Any other comments?