DSCP Application Form 2012-13 by U3CRs1

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									                      Diversity and Social Cohesion Program
                                   Application Form 2012-13
Please note: It is essential that you read the accompanying Diversity and Social Cohesion Program
2012-13 Application Information Booklet before you complete this form.

All sections of this form must be completed and emailed to dscp.applications@immi.gov.au by the
closing date. Supporting documentation in the checklist must be emailed with this form.

If you have questions, please contact the Department of Immigration and Citizenship (DIAC) on
1800 453 004 or email us at comprog@immi.gov.au.

Project Name & Funding
Name of Project:

Amount of funding being sought: $

1. Organisation & Contact Details
Name of Organisation:

ABN:

Previous Name of Organisation (if any)

Street Address:                                      Postal Address:
Number and Street:                                   PO Box:
Suburb:                                              Suburb:
State/Territory:                                     State/Territory:
Postcode:                                            Postcode:

Head of the Organisation                             Contact Person
Title:                                               Title:
Name:                                                Name:
Position Title:                                      Position Title:
Phone Number:        (0                              Phone Number:      (0
Mobile Number:                                       Mobile Number:
Fax Number:          (0                              Fax Number:        (0
Email Address:                                       Email Address:

Alternative Contact Person

Title:
Name:
Position Title:
Phone Number:        (0
Mobile Number:
Fax Number:          (0
Email Address:




                                                   Page 1 of 8
Is your organisation not-for-profit?                                      Yes        No
Note: for-profit organisations are NOT eligible for funding.

Is your organisation incorporated under the relevant law in your state or territory? Yes               No
Note: Unincorporated organisations are NOT eligible for funding.
A copy of your organisation’s certificate of incorporation should be scanned and emailed to
dscp.applications@immi.gov.au.

What date was your organisation first incorporated?

Is your organisation registered for GST?            Yes         No

Is your organisation one of the following:
            Community organisation                         Council/Local Government
            School                                         Tertiary Institution
            Service Club                                   Church Association/Religious Organisation
            Ethno-specific organisation                    Sporting organisation
            Youth organisation                             Service delivery organisation
            Other (provide details)

Website address (if available):


2. What is the ISSUE your project will address?
Diversity and Social Cohesion Program Grants projects must address social cohesion issues that are
related to instances of cultural, racial or religious intolerance. Projects may also seek to develop the
community capacity building skills of specific community groups that are under significant pressure due
to their cultural, religious or racial diversity. Projects should address issues in your local area and
promote respect, fairness, inclusion and a sense of belonging for everyone.

What is the main issue you want to address?
Describe the main issue of cultural, racial or religious intolerance that your proposal is addressing, or
why you need to develop the social cohesion capacity of a particular community:

(maximum 500 words)


Who is directly impacted by the issue?

(maximum 500 words)


What evidence of the issue can you provide?
How do you know that this is an issue for the community? Has there been community consultation,
meetings or other public behaviour around this issue? All proposals must be supported by appropriate
evidence of the issue or potential issue. Evidence may be in the form of press articles, formal research,
minutes from community meetings, letters to relevant authorities, documented informal contact with
community leaders/elders etc.

(maximum 500 words)


How is this issue affecting the wider community?

(maximum 500 words)


What is contributing to the issue?

(maximum 500 words)

                                                  Page 2 of 8
What programs are already in place to address the issue and how will this project address the
gaps?

(maximum 500 words)



3. What does your PROJECT involve?
What is your proposed project?
Write a brief outline of the project, including what you want to do to address the issue and who you
want to participate.

(maximum 500 words)


What are your overall goals for this project? What will success look like?
What difference is your project going to make? What do you hope to achieve by the end of the project?
How will this project benefit the community? Who will benefit from the project? What changes will you
see in your local community as a result of your project?

(maximum 500 words)


How will you measure the success of this project overall?
How will you evaluate your project activities?

(maximum 500 words)


What is the total duration of your project (in months)?

Where will the project activities take place (specify suburb/s or local government area)?

(maximum 50 words)


Who are the people likely to take part in your project and what are their cultural backgrounds?
How do you intend to engage with/involve these people in the project?

(maximum 250 words)


How will your project engage the wider community?

(maximum 250 words)


How will your project continue to have an impact on the community after it finishes? Will any of
the activities continue after the project is completed?

(maximum 100 words)



Project Activities
What are the key activities you are planning and how will they help to make a change in your
community?

Activity 1. Detail the activities you will undertake:

(maximum 50 words)

Commence Date            /   /       (ie DD/MM/YYYY)          Finish date   /   /
                                                    Page 3 of 8
Performance indicator
How will you measure the success of the activity? (include target numbers involved in each activity)

(maximum 50 words)

Expected Outcome/Result
What do you hope to have achieved by the end of this activity?

(maximum 50 words)


Activity 2. Detail the activities you will undertake:

(maximum 50 words)

Commence Date            /       /       (ie DD/MM/YYYY)       Finish date      /       /

Performance indicator
How will you measure the success of the activity? (include target numbers involved in each activity)

(maximum 50 words)

Expected Outcome/Result
What do you hope to have achieved by the end of this activity?

(maximum 50 words)


Activity 3. Detail the activities you will undertake:

(maximum 50 words)

Commence Date                /       /    (ie DD/MM/YYYY)       Finish date         /       /

Performance indicator
How will you measure the success of the activity? (include target numbers involved in each activity)

(maximum 50 words)

Expected Outcome/Result
What do you hope to have achieved by the end of this activity?

(maximum 50 words)


Activity 4. Detail the activities you will undertake:

(maximum 50 words)

Commence Date            /       /       (ie DD/MM/YYYY)       Finish date      /       /

Performance indicator
How will you measure the success of the activity? (include target numbers involved in each activity)

(maximum 50 words)

Expected Outcome/Result
What do you hope to have achieved by the end of this activity?

(maximum 50 words)


Activity 5. Detail the activities you will undertake:

(maximum 50 words)

Commence Date            /       /       (ie DD/MM/YYYY)       Finish date      /       /
                                                     Page 4 of 8
Performance indicator
How will you measure the success of the activity? (include target numbers involved in each activity)

(maximum 50 words)

Expected Outcome/Result
What do you hope to have achieved by the end of this activity?

(maximum 50 words)



Have any of your planned activities been undertaken in the community previously? Yes               No
If Yes, tell us about the outcomes of those activities. Who funded the activities and why has that
funding ceased? How will this project build on those previous activities?

(maximum 500 words)



Harmony Day activity
If you are seeking project funding of over $5000 you will need to include a Harmony Day activity
(see page 21 of the Diversity and Social Cohesion Program 2012-13 Application Information Booklet)

What is your Harmony Day activity?
Detail the activities you will undertake and how you will measure the success of the activity.

(maximum 100 words)



4. What is your CAPACITY to deliver this project?

Organisational Skills & Experience
Please describe the main business and activities of your organisation.

(maximum 200 words)


What is your organisation’s management structure and what relevant experience do those
involved in the project have?

(maximum 200 words)


Briefly outline your organisation’s ability to administer government funding and meet reporting
requirements.

(maximum 100 words)


Please provide details of any government funding your organisation has received previously.

  Financial Year              Amount                                Funding Source




                                                   Page 5 of 8
Are you seeking funding of over $20 000? If yes, you must also provide evidence of your
organisations past financial management.
This evidence includes copies of the organisation’s most recent annual audited financial statement and
annual report. A copy of the annual audited financial statement must be scanned and emailed with the
application to dscp.applications@immi.gov.au. If available, please provide a website link to your
organisation’s most recent annual report.



Community Support
Identify the key community organisations and individuals that are important to the success of your
project. For example if your project will be working with people from different cultural backgrounds,
name their community leaders and their organisation(s). Are there any mainstream organisations or
their representatives whose participation and support you need to make the project a success.

If you are suggesting a project which involves specific cultural or faith groups, you must have
the support of the Leaders/Elders of those groups.


     Name                Position              Organisation            Consulted           Support
                                                                                           Secured
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No
                                                                      Yes      No        Yes     No

NOTE: We may contact you to obtain copies of letters of support from these community
representatives at a later stage.




                                              Page 6 of 8
5. What is your budget?
Budget
Please provide a list of all the estimated project income and costs.
Enter funding as whole dollars rounded to the nearest $500 i.e. $25 500.

Income
Total amount of DIAC grant funding sought (excluding GST)                     $
Organisation’s contribution (including in-kind)                               $
Other income/funding (further details must be provided below)                 $
Budget items                                                    DIAC funding           In-Kind        Other Funding
Salaries & Wages
Salaries Oncost (10-15%)
Public Liability Insurance
Workers Comp Insurance
Administrative Costs (must be itemised at budget notes below)
Audit
Advertising/Publicity
Printing
Harmony Day Activity
Evaluation

Other – Any budget expenditure that exceeds $2000 will require a breakdown at project budget notes below.




TOTAL

Project Budget Notes:
Please consider the costs of:

          public liability insurance of $10 million,
          workers compensation insurance for all project employees, and
          an audited financial statement (mandatory for all projects over $20 000)




                                                      Page 7 of 8
Please provide a breakdown of administrative costs and any of the items that are greater than
$2000.

(maximum 200 words)


Have you sought funding and/or received funding for the same project from another source?
Yes         No
If Yes, please provide details:


Do any aspects of this project depend on funding from another source?                 Yes    No
If Yes, what are the implications for this project if the other funding is not approved?



6. Supporting documentation
Attachment checklist

       A copy of your organisation’s certificate of incorporation has been scanned and emailed to
       dscp.applications@immi.gov.au.

       If applicable, a copy of your organisation’s most recent annual audited financial statement has
       been scanned and emailed to dscp.applications@immi.gov.au – (mandatory for all projects
       seeking funding over $20 000).

       Evidence of the issue to support your application (eg press articles) has been scanned and
       emailed to dscp.applications@immi.gov.au.


7. Declaration
Declaration by Organisation’s representative authorised to sign (please tick all boxes)

       I have been duly authorised to make this application.

       I have read, understood and agree to abide by the requirements of the Diversity and Social
       Cohesion Program 2012-13 Application Information Booklet.

       The information given in this Application is true and correct to the best of my knowledge.

       The organisation will contact DIAC immediately if any information in this application has
       changed or is found incorrect.



Authorised by

Position in Organisation


Date    /    /




                                               Page 8 of 8

								
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