; template RDAYMN application form 10 11 (DOC)
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template RDAYMN application form 10 11 (DOC)

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									                Application Form

                ‘project name’ Project

 PROJECT NO. RAW-xxx-1011 (No. xxx)

        ……………………………………………………..
             Organisation Name


Please read the Project Brief before completing this Application.

Information
 The Application will be assessed on information provided and against
   criteria developed within the South Australia Works Program.
 Projects will be approved subject to the availability of funds.
 Please attach additional pages if necessary.

Send an electronic copy of your application and mail a signed hard copy
of your completed application and any supporting documents to:

“Private and Confidential
Name
Workforce Development Officer
Regional Development Australia Yorke & Mid North
Address”

Telephone: (08) xxx
Facsimile: (08) xxx
Email:     xxx
Part 1            DETAILS OF YOUR ORGANISATION

1.1      Organisation Information:

         Legal Name of Organisation:

         Trading Name:

         Is the organisation already registered with Regional Development Australia Yorke and
         Mid North as a Preferred Provider?

         Yes                    No     

         If Yes, complete 1.2, 1.3, and Part 2. If No, complete all of Part 1 and Part 2.

1.2      Nominated Contact Officer for This Project

         Title:

         First Name:

         Last Name:

         Contact:                                 Phone:               Fax:

         Email:

1.3      Are there other groups, organisations or consortium members involved in your
         proposal?

         Yes                    No     

         If yes, please provide details:

1.4      Organisation Details

         ABN:

         Type of Organisation:

         Street Address:

         Postal Address (if different to above)

1.5      Please provide a brief description of your organisation

1.6      Please provide two current referees from your local community or region that are
         prepared to supply evidence that supports your organisation and its ability to
         manage similar projects. Written references can be attached or their contact details
         listed below.
      Referee 1:      Contact Details:

      Ph:                    Fax:
      Email:

      Referee 2:      Contact Details:

      Ph:                    Fax:
      Email:

1.7   Have you applied for funding from any state or federal funded programs in the last
      2 years?

      Yes                    No

      If Yes, please detail and provide a contact person who can attest to your ability to
      manage Government funds.

      Contact Name:

      Phone:                 Fax:
      Mobile:
      Email:

      1.7.1     What experience does your organisation have in developing, planning,
                budgeting and reporting that will help in implementing this project?
Part 2           ABOUT THE PROJECT

2.1      Project Delivery

         2.1.1 How do you propose to meet the requirements of the project as detailed in the Brief?
         (You may submit attachments)

         2.1.2 What links and partnerships will be formed to provide the services?

         2.1.3 What personnel are to be involved, detailing their qualifications and experience?

2.2    Project Management

         How do you propose to manage the project and the services required in the Brief?

         Note: It is a condition of the Contract that a detailed Project Plan be developed which will detail
         the activities to be performed, by whom and the timelines. This Plan will form the basis of regular
         reporting to the Steering or Project Management Committee. Please forward a draft Plan with this
         application.

2.3      Participants

         2.3.1   How do you intend to recruit and service the targeted participants?

         2.3.2   How will you cater for participants from isolated areas of the region?

         2.3.3   How will you promote participants for work experience/voluntary work and
                 employment to potential employers (where appropriate to the project)?

2.4   Training

      Provide details of any training to be delivered as part of this project.

      Outline anticipated training, accredited/non-accredited units, nominal hours, on/off job training etc.

         TRAINING   MODULES/UNITS        ACCREDITED/       HOURS      MODE OF          PROVIDER
                                         NON-                         DELIVERY
                                         ACCREDITED




2.5      Project Outcomes

         2.5.1 What will indicate to you that the project has been successful? How will you
         measure this?
      2.5.2 What other outcomes would you expect to achieve? How will these be measured
      and reported on?

2.6   Budget

      Provide a detailed budget for the project, based on the South Australia Works funds
      available.

      Complete and forward the SA Works Budget template provided, incorporating funding (in-kind or
      cash contributions) from your organisation or other partnerships. Detail any other sources of
      funds that have been secured or proposed. (Note comments about the Budget details in the
      Brief.)

2.7   What processes do you have in place to recognise and address risks associated
      with the delivery and management of the Project?

      Complete Risk Management Plan – Attachment 1.

2.8   How will you evaluate the project? What evaluation would be considered
      important?


NB    Refer to Brief for all documents that need to be forwarded to complete the Application.
DECLARATION

An authorised representative of the applicant organisation must complete this declaration.

I declare that the information I have given on this form is complete and correct and that the organisation I
represent supports the project.

I have read and understood the Project Brief.

I agree that information about my organisation’s project in this Application Form may be reproduced in
South Australia Works in the Regions promotional and media material.

I agree that individuals or organisations mentioned in this application may be contacted as part of the
application assessment process.

I understand that my application may be provided to other State government funding programs as
appropriate.


Name of representative:

First Name:

Last Name:

Position:

Organisation:

Telephone:

Date:       /   /                ………………………………………………
                                        Signature of Representative


If you have any problems or questions in relation to the Application Form, please call:

name
Workforce Development Officer
Regional Development Australia Yorke and Mid North
Ph: (08) xxx
Mob: xxx
Attachment 1.             Risk Management Plan




                                    Likelihood




                                                                                   Impact
Risks                                            Consequences                               Strategies


Ineffective Steering                              Project at risk                          
Committee
Inability to source participants                  Reduced capacity to meet                 
                                                   project objectives
Poor management of Work                           OH&S risk to participants                
Placements/Experience                             Ineffective placements
Loss of Project team                              Inability to meet program                
                                                   objectives
                                                  Reduced quality of services
                                                  Reduced growth
Inability to meet deadlines                       Reduced capacity to meet                 
                                                   project objectives
                                                  Reduced quality of services
                                                  Reduced funding
Changes to facilities/                            Reduced capacity to meet                 
equipment arrangements                             deadlines
Inability to meet financial                       Reduced capacity to                      
agreements                                         complete project deliverables
                                                  Reduced Funding
Not meeting legislated                            Compliance issues                        
requirements
o Equal opportunity
o OHS&W
o Child Protection
Unable to meet the reporting                      Delayed funding                          
conditions of grant and                           Reduced funding
achieve KPI’s                                     Reduced likelihood of further
                                                   projects
Changes to goodwill                               Reduced quality of services              
                                                  Reduced capacity to meet
                                                   demand
                                                  Increased costs
Other possible Risks (please
list)

Key
Likelihood                     Impact
1 No chance                    1 No impact
2 Not very likely              2 Minor impact
3 Somewhat likely              3 Moderate impact
4 Very likely                  4 Significant impact
5 Definite                     5 Major impact

								
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