Cassowary Coast Regional Council Community Assistance Scheme Application

Community Assistance Scheme (CAS)

Community Grants Program Application Form Further information and application forms may be obtained by telephoning Council on 1300 763 903 Information and application forms are available on Council's web site: www.cassowarycoast.qld.gov.au

Council provides financial assistance to community organisations and individuals who make a positive contribution to the development of the Cassowary Coast region's environmental, social and cultural values as well as its sporting, recreational and lifestyle values. All applications are assessed on their merit against Council's Community Assistance Scheme policy and guidelines, as well as selection criteria set out in the policy and guidelines.

Organisations applying for funding under the Community Assistance Scheme must comply with Council's policy. All applications must be submitted to Council by hardcopy. Council holds one round of community grants for community groups each year, generally from August to October, with funding approvals capped at $3000.

It is recommended that you read the Community Assistance Scheme guidelines prior to completing this application form. Ensure that your application is printed in BLOCK LETTERS USING black or blue ink. Please ensure that you complete all sections, tick boxes where applicable and attach all requested documentation. Incomplete or late applications WILL NOT be considered for funding. Faxed or emailed applications will not be accepted.

 Ask your local Council Grant Liaison Officer if you are unsure about any part of your application.  It is important that you keep a copy of your application to help prepare the Outcome Report if you have been successful in receiving Community Assistance Scheme funding.  Return your completed application and support material to:

Cassowary Coast Regional Council PO Box 887 INNISFAIL Q 4860. 2 Cassowary Coast Regional Council Community Assistance Scheme Application

Cassowary Coast Regional Council Community Assistance Scheme Application Form 2014 3 Cassowary Coast Regional Council Community Assistance Scheme Application

APPLICATION SUMMARY

APPLICANT DETAILS Council contact details Applicant name (name of individual, group or organisation) Please contact your Council for Grant contact details if not indicated below. Grants Liaison Officer Kath Barnett Contact person’s name (where applicant is a group or organisation ) Phone Mobile This is the person who will be responsible for the project and completing the Outcome Report. 40302255 0419 308 530 Email: [email protected]

Postal address Council Postal Address Street or PO Box Cassowary Coast Regional Council Town / Suburb PO Box 887 State Postcode 4849 INNISFAIL Q 4860 COMMUNITY ASSISTANCE SCHEME CATEGORY – CHOOSE ONE

1 Sport & Recreation 2 Community & Youth 3 Environmental 4 Community Events Development Development Development

PROJECT NAME (max 10 words) 5 Arts & Cultural Development

Describe your project or activity. (Minimum 75 words) Please use this section to describe the rationale and objectives of your project.

Project start date from Section 2.1 Project end date from Section 2.1 Outcome Report due Section 3.1 Total cost of project from Section 3.2 $ CAS Grant requested from Section 3.2 $ COUNCIL USE ONLY Date: The CAS grant is approved not approved

Amount requested (whole $ only) $ Amount approved (whole $ only) $ 1. APPLICANT DETAILS 1.1 Applicant Type

Are you applying as an individual a group/unincorporated body an organisation (please tick ONLY ONE):  Go to 1.2  Go to 1.3  Go to 1.4 1.2 Individual

If you are under 18 years of Title: Mr Mrs Ms Other (please specify): age please give your date of birth: Given names: Family name: Do you have Australian citizenship or permanent residency status? Y N Are you: Male Female Go to 1.5 1.3 Groups

Collectives or cooperatives are Name of group: community groups or groups of like minded that are not Name of auspicing organisation/individual incorporated but must be Note: this organisation or individual must complete auspiced by an incorporated Section 1.8 organisation including Local Government, or an individual Details of accountable person in group with an ABN. One person must be Title: Mr Mrs Ms Other (please specify): nominated as the accountable representative of the collective Given names: for management, reporting and Family name: financial matters. Go to 1.5

1.4 Organisation Eligible organisations include not-for-profit organisations and Legal name of organisation: individuals that are either based in the Cassowary Coast or able to demonstrate how Details of contact person in organisation their project will directly benefit the Cassowary Coast Title: Mr Mrs Ms Other (please specify): community. Given names: Organisations must be registered under law as either Family name: incorporated associations or a Role of contact company limited by guarantee. person: What is your organisation’s legal status? Go to 1.5 (eg limited by guarantee; incorporated; etc) 1.5 Applicant Contact Details Street address: Suburb/town: State: Postcode: Postal address:

Suburb/town: State: Postcode: Telephone: Work: ( ) Home: ( ) Fax: ( ) Mobile: Email: Website address

1.6 Community Assistance Scheme Grant History

Have you or your group/organisation previously applied for a Council grant? (ie CAS / RADF) Yes No

If you were successful has that grant been successfully acquitted? Yes No

1.7 Australian Business Number (ABN) Details

Will you/your organisation Yes – Provide your ABN details below be responsible for the financial management of No – An auspicing body will be administering any grant that I receive on my/our the grant if this application organisation’s behalf. Complete section 1.8 below is successful?

What is your ABN?:

In what name is the ABN registered?

What is your trading name or professional name (if relevant)?

Are you registered for GST? Yes No

1.8 Auspiced Application

Please note: . All individuals who do not have an ABN, groups/collectives or unincorporated organisations must nominate an individual with an ABN or incorporated organisation to take responsibility for any grant that may be offered. . Only complete this section if you are nominating an accountable organisation or individual to administer the grant on your behalf who will also be responsible for submitting a financial report at the end of the project.

Who is your auspicing arrangement with? an incorporated organisation an individual with an ABN Name of auspicing organisation or individual:

Contact person for auspicing organisation:

Position of contact person (if relevant): ABN of auspicing organization or individual

Are you registered for GST? Yes No

Postal address of auspicing organisation or individual: Suburb/Town: State: Postcode:

Telephone: Work: ( ) Home: ( ) Fax: ( )

Mobile: Email:

Certification of Auspicing Organisation/Individual Details Go to 6.2

2. ABOUT THE PROJECT

2.1 Project Summary

Your application will not be eligible if your project begins before the grant is Start date: ______Finish date: ______approved.

Does your organization have public liability insurance? Yes (Please provide copy) No

2.2 Show evidence of genuine community interest and local support for this project. (Minimum 75 words)

2.3 How will your project/activity benefit the broader community? (Minimum 75 words)

2.4 Please estimate the following _____ Total number of activities involved _____ Total number of volunteers at event/activity

2.5 Please outline the steps you have taken to address the issues of workplace health and safety, public liability insurance, copyright and relevant licences and planning approvals.

3. PROJECT MANAGEMENT All applicants must complete this section

3.1 List each stage of the project from start to finish Write a date in the column beside each stage to indicate when you expect to complete that stage of the project.

Project Stage Expected Completion Date

Complete the CAS Outcome Report (no later than 8 weeks after the finish date)

3.2 Project Budget – Income and Expenses Please complete this budget template to account for all costs of your project. Round all amounts to whole dollars Enter all other grants for which you have applied and mark an asterisk against those grants which have already been approved. The amounts requested in the third column (CAS) show how much CAS funding you are seeking for each expenditure item. Note: If you are GST registered (see 1.7) Council will pay the grant plus GST. If you are registered for GST, your expenditure and income should be exclusive of GST. If you are not registered for GST, your expenditure should include the GST to be paid.

Total Item Total Item A - Expenditure/Project Costs Cost Cost Excluding Including GST GST

A - Total cost of your project, event or activity

B - Income - i.e. Cash contributions, proposed food sales, proposed entry fees, in-kind support etc

B - Total project, event or activity income contribution

C - Community Development Grant Request Expenditure (A) Less Income (B)

= Grant Requested ( C ) Please note CAS grants are capped at $3,000.

3.3 Budget Notes When you have completed your budget the Total Expenditure and Total Income must be equal. The CAS grant should be listed twice – once in the income column and once in the expenditure column. 1. Materials/Preparation/Equipment 2. Office costs/Admin overhead 3. If applicable, income earned from project 4. Cash/In-kind/Self investment/Value of materials Ie food sales, entry fees, etc which are to be provided in-kind 5. Examples: Australia Council / Education Queensland/Local Government / Gambling (A = Expenses) - (B = Income) = (Grant Request) Community Benefit Fund / Federal Government

4. STATISTICAL INFORMATION

This information is for statistical use only. It will not affect the assessment of your application. Please help us to improve our services by filling out the questionnaire below.

4.1 Community groups which will specifically benefit from the project (if applicable)

Aboriginal people Older people (over 55 years of age)

Torres Strait Islanders People with a disability

Australian South Sea Islanders Men

Children and young people (30 years and under) Women

People from culturally and linguistically diverse Families backgrounds (CALD) Disadvantaged (inc homeless, low income, Young parents unemployed.

Other (Please provide Details)

5. ESSENTIAL SUPPORT MATERIAL

Please label all support material with your name and address. Tick those support materials which you have attached to this application All Applicants

Evidence of costs ie quotes for significant amounts >$300

Evidence of public liability if applicable, relevant permissions / permits / approved site management plans if applicable

Evidence of community support - up to three letters that provide relevant comment in support of your application

Evidence of Incorporation

6. Information Privacy and Right to Information

I consent to the information contained within this application being disclosed to or by Cassowary Coast Regional Council for the purpose of assessing, administering, monitoring and evaluation and promoting this program. The Information may be anonymised and used for statistical purposes The Council may contact other funding agencies to verify grants requested from other funding agencies in support of your project. Information Privacy and Right to Information If your application is successful, the Council may disclose the following Information. . the information you provide in your grant application . the amount of funding you receive . the information you provide in your outcome report and . text and images relating to your funded activity.

7. CERTIFICATION 7.1 All Applicants I, the undersigned, certify that: I have read and will abide by the Community Assistance Scheme Guidelines Information for Applicants together with any published revisions which are available at www.cassowarycoast.qld.gov.au. I have read and understood the Information Privacy and Right to Information Statement and agree t the use and disclosure of information as outline in the Statement.

To be signed by the Chair, President or Chief Executive of the Applicant organisation / individual.

 I certify that to the best of our knowledge, the information given in this document, is true and accurate.

 I understand that Council have the right to request a current financial statement for the purposes of assessing grant application.

 I understand that if funding is allocated to our project, event or activity, I will be required to accept the funding in accordance with the Cassowary Coast Regional Council's conditions of funding (refer to section 7 of the guidelines)

 I certify that the project, event or activity will be completed within the funding round.

 I understand that if Cassowary Coast Regional Council approves the grant, I will be bound by the contents of my application to carry out my project as I have described and my application will form part of my funding agreement with Cassowary Coast Regional Council.

 I understand the Project Report & Acquittal Form accompanied with receipts and invoices, will be completed and returned to council within eight (8) weeks from the end of the project and

 I understand that if the conditions of funding are not complied with: (i) Council will recover the funds allocated and (ii) Future applications for funding from Council will not be considered. The Council treat all personal information in accordance with the Information Privacy Act 2009. The provisions of the Right to Information Act 2009 apply to documents in the possession of the Council.

Signature: Date: If you are under the age of 18 your legal guardian must also sign this application Name in full: Position in group or organisation: (if applicable)

7.2 Certification by Auspicing Organisation/Individual Please note: Both the applicant and the auspicing organisation/individual are considered responsible for ensuring the acquittal of grants and both could be deemed ineligible to place further applications to Council until all grants have been satisfactorily acquitted. I/my organisation agree/s to administer the grant that may be offered to the applicant on their behalf And that the information stated in 1.8 of this application is true and correct.

Signature: Date:

Name of Auspice Body:

Contact person’s name in full:

Position in group or organisation: (if applicable)

8. TICK LIST

 Is your organisation eligible to apply?

 Have you answered all the questions as completely as possible?

 Is the budget section completed, and does it add up?

 Is the application signed by the appropriate authorised representative?

 Have you attached a certificate of incorporation?

 If you do not have an ABN, have you completed an signed the Withholding Tax Form (Statement by a Supplier)

 Have you attached a copy of insurance certificate of currency if applicable to activity?

 Have you attached quotes for any services or products required for the project?

 Have you included any letters of support for your project?

 Have you kept a copy of the application for your own records.

Cassowary Coast Regional Council Community Assistance Scheme Application Form 2014