APPLICATION FORM Round 3 (Grants up to $20,000)

APPLICATION FORM – Round 3 (grants up to $20,000) Applications close 5pm, Friday 23 June 2017 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 Other 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 Other Name Position Held Phone No. Email Mobile PROJECT INFORMATION Project Title Make it catchy! Project Summary Describe the project & its main outcome/s (50 words max). Grant Amount Requested Population Maximum $20,000, use whole $ only Project location Town Name State Post Code Project location Project location Project location Local Government Area Project location Proximity to nearest Capital City Project location (e.g. 1450 km NE Perth, WA)

Priority Outcome Areas (Projects must fit within at least one of these and may fit within several) Community partnerships & Education engagement and Youth Anti-social and criminal collaboration retention behaviours Health and wellbeing of at-risk Increased participation in Early years engagement and individuals and population volunteering/mentoring/leadership development groups Access, information & pathways to Improved access to employment Reduced economic vulnerability services

CATEGORY WHICH BEST DESCRIBES YOUR PROJECT (Please indicate one only) Culture Economic Education Environment Social Welfare Health

PRIORITY POPULATION GROUP (Projects must target at least one of these) Women & children at risk of / experiencing domestic Women & children from Aboriginal & CALD backgrounds & family violence Aboriginal children & youth aged up to 16 years Families experiencing disadvantage At risk youth Does your project involve working directly with children / youth under 18? Please indicate one only Yes No If YES, does your organisation have policies and procedures regarding working with children, Working Yes No with Children Checks, and the handling of child abuse complaints? Please indicate one only

Please answer the following questions and submit either by completing this form or by submitting as a DVD or web link, along with supporting documentation. If choosing a visual application, please note that it does not need to be of a high production standard, but needs to be audible and visible and the information presented needs to be clear and respond to the questions below. You will still need to complete the cover page and budget to send with your clip. 1. TELL US ABOUT YOUR ORGANISATION Provide a brief overview e.g. mission, founding date, programs / distinctive attributes, number of people involved i.e., enrolments, staff, volunteers, engagement with other groups etc. For 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.

2. TELL US ABOUT YOUR PROJECT. What is the need it addresses and what would the grant funds be used for? When and where will it happen? What you will actually do – what are the project’s aims, objectives, timeframes? What will the funds be used for? What is the need in the community? What are the expected outcomes? How will the project benefit the community?

3. WHAT OUTCOMES ARE YOU HOPING TO ACHIEVE? What change will you be able to demonstrate and how will you do this?

4. WHO ELSE IS YOUR GROUP WORKING WITH ON THIS PROJECT? Who will be involved? What will they be doing? Are they contributing to the project with cash and/or in-kind support? List other organisations that are supporting this project and attach signed supporting letters. NB: If application is regarding property owned by a third party a letter of consent / support must be attached (e.g.: halls owned by local government)

5. HOW IS THIS PROJECT DIFFERENT TO PAST APPROACHES? Why will this be better than past approaches? 6. PLEASE PROVIDE A DETAILED OUTLINE OF HOW YOU WILL EVALUATE / MEASURE THE OUTCOMES OF THE PROJECT How will you know the project is successful? What will occur if the project is successful that doesn’t occur now? What are the broader implications of the project outcomes and findings? How will you measure that you attained the outcome that your group is seeking? How will you communicate the success and learning of this project and who will you be sharing it with? How many people do you expect to reach? Please provide measurable numbers e.g. train 25 people, reach 60 families.

7. HOW WILL THE CHANGE ACHIEVED THROUGH THE PROJECT BE SUSTAINED BEYOND THIS GRANT? What’s your group’s strategy to sustain the project in the medium to long-term? Please consider finances and resources.

8. COULD YOUR ORGANISATION UTILISE ASSISTANCE FROM GREATER CHARITABLE BANK STAFF VOLUNTEERS FOR THE DELIVERY OF THIS PROJECT? If your organisation is located less than 30 minutes travel by car from the nearest Greater Bank branch, and would be interested in hosting Greater Bank staff as volunteers. Please note this will not be considered in assessing grant applications.

YES NO

PROJECT BUDGET Please provide details of the project income and expenditure, including any confirmed or unconfirmed income and any contribution from your organisation – either cash or in-kind.

PROJECT BUDGET

INCOME $ EXPENDITURE $

FRRR Grant Request

IN-KIND SUPPORT $ IN-KIND SUPPORT $

TOTAL TOTAL

APPLICATION CHECKLIST ENSURE YOU HAVE COMPLETED THESE SECTIONS Application Cover Sheet Project Information Project Finances Organisation Information

ENSURE YOU HAVE ATTACHED THESE DOCUMENTS - All supporting material MUST be submitted with the application Organisation Financials - either current profit & loss / balance sheet OR last audited statement (ESSENTIAL) Certificate of ABN or Incorporation - or attach printout from www.abr.business.gov.au (ESSENTIAL) Letters of support for project (OPTIONAL, but very highly regarded) Quotes to support budget items (OPTIONAL, but very highly regarded)

PLEASE COMPLETE THE BELOW CERTIFICATION MUST BE HAND-SIGNED BY HEAD OF ORGANISATION OR WILL BE INELIGIBLE FOR FUNDING 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 or as determined in the grant agreement. I/We agree for FRRR and donors to publish stories and photographs of grants funded. HEAD OF ORGANISATION EG. CHAIR, CEO, PRESIDENT

NAME: SIGNED

POSITION: DATED ORGANISATION NAME: (As appears on your ABN or INC. Certificate) PLEASE SUBMIT YOUR APPLICATION & ATTACHED DOCUMENTS, VIA POST OR VIA EMAIL (preferred) FRRR: I4CI, PO Box 41, BENDIGO VIC 3552 [email protected] Hour Please estimate the time taken to complete your application? s e.g 0 3 = 3 Hours On a scale of 1= Easy to 5= Hard how would you rate this application process?