Caroona Coal Project
IMPORTANT NOTE: The Caroona Coal Project Community Fund is structured to
benefit the communities of Gunnedah and Liverpool Plains Shires. Please refer to
the Community Fund and Priority Focus Areas brochures for further details about
this and other funding guidelines prior to completing this application.
COMMUNITY PARTNERSHIP FUND for applications OVER $5,000
Date of application Date received (Office use only)
Q1 PREVIOUS FUNDING
Have you previously applied for funding under this program?
If so, when do you last apply?
Was your application successful?
Q2 ORGANISATION DETAILS
Legal name of organisation
Organisation location address
Organisation postal address
Type of organisation
Private Enterprise or for-profit entity Local Government
Non-profit entity, including registered Community Council (Indigenous Council)
charities State Government funded agency
Association Other – (please specify)
Business phone Business fax
Australian Business Number (ABN)
Is the organisation GST registered?
Is the organisation incorporated?
Australian Company Number (ACN) if applicable
Q3 BRIEF ORGANISATION HISTORY
How long has the organisation been operating?
Who is the organisations major clientele?
What other projects has the organisation managed? (100 word limit)
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Q4 CONTACT PERSON/S DETAILS
Primary contact person for correspondence - Name and position title
Primary contact person e-mail address
Work phone Mobile phone Fax
Secondary contact person for correspondence - Name and position title
Secondary contact person e-mail address
Work phone Mobile phone Fax
Q5 PROJECT DETAILS
(A) What is the name of your project?
(B) With which focus area/s does your project best relate?
Education and Training Community Development
Indigenous Development Environment
Health
(C) How does your project relate to one or more of the Priority Focus Areas for funding? (250 word
limit)
(D) What need or issue has been identified within the priority focus area that needs addressing?
(150 word limit)
(E) Why does the identified need or issue in the priority focus area need to be addressed? What are
the current impacts caused by this need or issue? (100 word limit)
(F) What is the rational of your proposed project to support your proposal? I.e. do you have any
feasibility studies, outcomes from consultations, surveys or gathered statistics? Does your project
align with regional plans? Please attach support documents. (100 word limit)
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(G) What is your organisations proposed solution to address the identified need or issue? i.e.
provide a summary of the proposed project: (500 word limit)
(H) What are the expected outcomes of your project? I.e. what benefits will be gained by the
community? (250 word limit)
(I) How will your project impact on other organisations? I.e. will your project enhance or compete
with other regional service or product providers? Is this a new and/or innovative solution to
address the identified issue or need? (100 word limit)
(J) Who supports your project? Please provide letters of support from relevant organisations or
individuals.
(K) Is the project a long term solution to address the identified issue? How will the project remain
sustainable after funding has ceased? Please provide details of ongoing financial sustainability and
proposed management and maintenance structure. (400 word limit)
Q6 BENEFICIARIES
(A) Who are the principal beneficiaries or target group/s?
(B) How many people will directly benefit from the project/program?
(C) Which geographic area will benefit from the project? Please specify.
(D) Describe the impact/s the project will have on the community or target group/s. (150 word limit)
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Q7 FINANCIAL MANAGEMENT
(A) Are there any other direct stakeholders/partners? Please provide the names of organisations,
departments or individuals that are partnering your proposal and include the roles of each including
financial and/or in-kind contribution. Please provide letters of support from other
stakeholders/partners. Further information may be required to demonstrate the previous
experience of partners or associated stakeholders.
(B) What financial management systems are in place? Who is responsible for the financial
management of the project/activity?
(C) How will your project be implemented? Please provide a project plan that indicates relevant
details of your project such as timeframes, tasks, milestones, resources, responsibilities,
implementation process. If relevant apply associated costing for each.
Please attach a project plan to your application.
Q8 EVALUATION AND REPORTING
Please provide measurements that will be used to determine the success of the project.
Key Performance Indicator/s Measurement Method/s
Example only; Example only;
Increased numbers of skilled workers to meet New types of training and number of courses
shortages. available.
Creation of new jobs by providing education and Number of students and courses completed. Skills
skills development. Audits. Unemployment levels
Q9 FINANCIAL MANAGEMENT
(A) What is the total amount of funding required for your $
project/activity to proceed. NB This amount should be the same
as the total budget figure in Q11.
(B) How much funding is being sought from the Caroona Coal $
Project Sponsorship and Donations Program in total?
(C) How much is being sought in this financial year? $
(D) OTHER FUND CONTRIBUTORS: Please list below the names How much Indicate if
of any other sources of funding requested including: funding has funding is
Government: Local, State and Federal been confirmed or
Other funding providers requested the date that
Self funding from other confirmation
Or other organisations funding of the funding
sources? proposal/s
success is
expected.
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$
$
$
$
$
(E) Total amount requested from other funding providers. $
(F) Total amount confirmed from other funding providers. $
(G) Over what period is sponsorship or donation support being From To
sought? / / / /
(H) How specifically will you spend use the proposed cash/in kind support?
(I) What contribution will your own organisation or community/volunteers make towards the
project/activity? E.g. volunteers’ time or funds already raised.
(J) Tax deductibility status: While it is not essential to have tax DGR Status
deductibility status it may be of advantage. Has your organisation
been granted Deductible Gift Recipient (DGR) status? If DGR Yes
registered please attach evidence in the form of a letter from the
Australian Taxation Office. No
Q10 FUNDING ACKNOWLEDGEMENT
If your proposal is successful, how will BHP Billiton Caroona Coal Project be acknowledged? NB:
Q11 PROJECT BUDGET
Insert rows as required
Item Type e.g. wages, Estimated In-kind value Name of Cash Date funds
e.g. existing Funding required are
approvals, surveyors, Cost $
or Partner or in not covered required
construction, (exclude partnership kind partner in the in-
consultants, equipment GST) contributions if applicable kind value
hire, labour, rent, volunteer column
administration. wages etc.
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
Total $ $ $
Please note: A breakdown of item line calculations e.g. wages may be required. Evidence of
costing may also be required e.g. valuations, quotes, quantitative surveys.
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Payment Details
Should your application be successful; the Caroona Coal Project will require additional
information for payment/s. To streamline the payment process, please provide a separate letter
(on a letterhead) that states; the name, location and postal address of your organisation, A.B.N.
and/or A.C.N. (if applicable), the primary contact person’s name and contact details including
phone, fax and email address, and banking details of the organisation including the name of the
Financial Institution, Account Name, BSB number and Account Name.
Support materials
If support materials such as videos, sound cassettes, photos, or original documents are sent,
we cannot guarantee their safe return.
Checklist - I have attached the following:
Payment details
Copy of Deductible Gift Recipient (DGR) status
Project Plan
Letters of support from beneficiaries
Letters of support from relevant organisations or individuals.
Feasibility study, survey data or rational support documentation if relevant
Other:
Send your application to:
Tania Mc Shane
Community Relations Coordinator
BHP Billiton Coal Mines Australia Pty. Ltd.
Caroona Coal Project
Cnr Hawker and Nowland Sts,
Quirindi NSW 2343
Telephone 02 6746 4606
Mobile 0428 400 625
Email Tania.L.McShane@bhpbilliton.com
BHP Billiton Community Partnership Fund applications over $5000 will be assessed on a
bimonthly basis. Applications should be received at least three months prior to commencement
of the project to be considered. In some instances it may be necessary to obtain additional
information from applicants to assist in the assessment.
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Declaration
I the undersigned declare the information provided to be a correct and honest description of our
organisation and/or events and the support needed.
Signed: ……………………………………………
Name of Signatory: ……………………………………………
Date: ……………………………………………
Completion and lodgement of this application form does not guarantee support from the BHP
Billiton Caroona Coal Project Community Fund.
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