Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

CRSFP ACP Cat2 application form by lD0581

VIEWS: 5 PAGES: 17

									                                          2012-13 APPLICATION FORM
                            ACTIVE CLUB PROGRAM & CATEGORY 2
            COMMUNITY RECREATION AND SPORT FACILITIES PROGRAM
                            Facility Development Funding Application Form

                                             Applications Close Monday 30 April 2012




How to complete this form
Before entering any information into this form:
   Save the application form on your computer so that information will not be lost.
   Please note: this form has been designed for MS Word 2007 or later. If you have
    problems completing the form, contact the Funding Services Team on (08) 7424 7708.


To enter information into the form:
   Use the tab key to move from field to field, or click with your mouse into the relevant
    field. A black highlight will appear indicating where you start entering your information.
    The fields will expand to accommodate the amount of information you wish to enter.
   Fill tick boxes by clicking on the relevant box to insert an X. To unmark a tick box, click
    on the X you want to unmark.
   To go backwards, click your mouse into the relevant field or hold down the shift key and
    press tab.
   Please complete all sections of the form. All requested information must be provided for
    your application to be considered.


Once completed:
   Have the Declaration section of the Application Form signed by two authorised
    representatives of your organisation. Please note, at least one representative must be a
    member of the organisation Board/Management Committee.
   Post or personally deliver the completed application form with all of the essential
    supporting documentation to the Office for Recreation and Sport (details on back of
    application form) by the closing date.


Please note
   Organisations that apply for $20,000 or less and meet the Active Club Program (ACP)
    eligibility criteria will be first assessed through the ACP process. Those not
    recommended through this process will be given a second chance through the
    Community Recreation and Sport Facilities Program.




                                                                               Page Number:
                                                   2012-13 APPLICATION FORM
                                   ACTIVE CLUB PROGRAM & CATEGORY 2
                   COMMUNITY RECREATION AND SPORT FACILITIES PROGRAM
                                    Facility Development Funding Application Form
       Only complete this form if you are applying for a grant up to $200,000.

       BEFORE YOU START
       Putting together a strong application takes time and energy, so it is important that you read
       the guidelines carefully, complete this application in full, and ensure that all of the
       information to be submitted with your application (see list below) is provided. Incomplete
       applications may be deemed ineligible and not assessed.
       Applicants are encouraged to contact the Funding Services Team prior to submitting an
       application to determine suitability for funding.
       Phone:     (08) 7424 7708
       Email:     ORSGrants@sa.gov.au
       INFORMATION TO BE SUBMITTED WITH YOUR APPLICATION
Item                                                                       Checked        Advice Notes
If you are not the landowner, have the Landowner Consent Form                             The Landowner,
(refer Section 9) completed, confirming consent for the project.                          Council and Peak
                                                                                          Body may need
Where Council is not the Landowner, have the Council Support                              some time to
Form (refer section 10) completed, confirming support for the project                     consider your
                                                                                          request for
Where applicable, have the Peak Body Support Form (refer section                          support, so you
11) completed, confirming support for the project                                         are strongly
                                                                                          encouraged to
Your most recent annual financial statement certified by the                              contact them at
President /Treasurer or audited by a qualified accountant.                                the earliest
                                                                                          opportunity.
A copy of building works drawings or concept plans for the project.

Project quote/s and evidence of in-kind support (refer question 26).

Evidence of cash support (refer question 27).

If development approval is required, copies of all permits/approvals
obtained so far. If development approval is not required, a letter of
verification from the Planning Section, or equivalent of your local
council (refer question 22).
Where applicable, the completed Volunteer Support Form (refer
Section 12).                                                                     NA

Where applicable, (refer question 15) letters of support for the
project from each of the user groups.                                            NA

Where applicable, a copy of the planning document which
justifies/prioritises the need for the project (refer question 18).              NA

Where you are applying to redevelop an existing facility, provide
photos that clearly demonstrate why the redevelopment is needed.                 NA




                                                                                      Page Number:
Advice Notes                    SECTION 1 – APPLICANT DETAILS
Please ensure that your
organisation is eligible to
                                1. Is your organisation a holder of a Gaming Machine Licence?
apply. See the Guidelines
for eligibility criteria.           YES (if yes, you are NOT eligible to apply. Please DO NOT continue)
                                    NO (please continue)

If you are unsure of your
incorporation number,
                                2. Name of Organisation: (as it appears on your Certificate of Incorporation)
please call the Business
and Consumer Services on
131 882. Or visit the ASIC
website at: www.asic.gov.au     3. Certificate Incorporation number (if applicable):

If you are a local council or
school leave question 3
blank.                          4. Does your organisation have an Australian Business Number
                                   (ABN)?

                                    YES (provide number):

                                    NO


If you are unsure, please       5. Is your organisation GST registered?
call the Australian Taxation
Office on 13 72 26.                 YES

                                    NO (see Guidelines for information on Grants and GST)

                                6. Street address and details of your organisation:

                                Street Address:

                                Suburb/Town:

                                Postcode:

                                Phone:                (08)

                                Fax:                  (08)

                                Email:

                                7. Postal address of your organisation

                                Address:

                                Suburb/Town:

                                Postcode:




                                                                                            Page Number:
All application                 8. Name and details of contact person for this application:
correspondence will be
directed to the person via
the postal/email address        Title:
provided.
                                First Name:
Please use an address that
will be checked at least
weekly.
                                Surname:

                                Position:

                                Phone: (b/hours)         (08)

                                Mobile:

                                Email:

                                9.   Postal address of contact person for this application:
                                     (if different to above):

                                Postal Address:

                                Suburb/Town:

                                Postcode:



Advice Notes                    SECTION 2 – GENERAL PROJECT INFORMATION
We will use this name on all    10. Project name:
correspondence. Please
use 10 words or less (for
example Madone Oval
Lighting Project).



Briefly describe what the       11. What does your project involve?
project entails/what are you
going to do?




Funding is only available for   12. Project Timelines:
projects that commence
once a grant agreement has
been finalised – February       Estimated Start Date:
2012.
Projects must be completed      Estimated Completion Date:
within 24-months.


                                13. What is the physical address where the project will occur?

                                Facility Name:

                                Street Address:

                                Suburb/Town:

                                Postcode:


                                                                                    Page Number:
Advice Notes                        SECTION 3 – PROJECT NEED
Provide an overview of the          14. Why is the project needed?
reason/s why this project is
needed. For example; it is
needed due to OH&S
reasons, increased facility
usage, no such facility
currently exists etc.
Where applicable, attach
photos or other information
to support your reason/s.

Provide a list of all groups        15. What user groups will benefit from the project? (If more space is
(internal to your organisation          required, please attach a separate sheet using the same headings as belo w)
and external users) that will
benefit from the project.
                                    User Group                          How often do/will      Number of participants
Provide a letter of support for                                         they use the           that will benefit
the project from each of the                                            facility per week
groups listed.
                                    e.g. Madone Junior Badminton Club   Use facility 2xwk      Club has 50 members
SCHOOL APPLICANTS:
provide details of those
groups (i.e. sport clubs) that
will benefit from the project
outside of regular school
hours.


Please identify the gender          16. Who will the facility be utilised by?
and age group that the the
facility will benefit (select all
that apply).                            Male                      Female
                                          0-4         5-12          13-18         19-25         26-54          55+


For example, explain how            17. Once the project is completed how will it assist your organisation
the project will assist you to          to increase its capacity for growth?
increase members/
participation numbers or
generate revenue?


                                    18. Has the project been identified and prioritised as a result of a
                                        planning process? (e.g. identified in a local council plan, state peak body
                                        plan, national body plan, or your organisation’s strategic or operational plan)

                                        Local Council Plan (attach a copy)

                                        State level organisation plan (attach a copy)

                                        Own organisation plan (attach a copy)
                                        Other plan (attach a copy)

                                        No, has not been prioritised in a plan (complete question below)
                                    If no, provide a rationale for why the project is a strategic priority for
                                    your organisation:




For example, is the project         19. Does your project link in with other active recreation or sport
part of a multi-sport                   facilities in your locality?
complex/sporting hub? If so,
                                                                                                 Page Number:
provide a list of other clubs
located at the hub.                    YES (complete question below)
If a trail project, will it link       NO
with other trails in the
locality?                          If yes, please explain the link




Advice Notes                       SECTION 4 – PROJECT SUPPORT
If your organisation is not the    20. Who is the owner of the land where the project is to be located?
landowner, the landowner
must complete the                      Your organisation (attach a copy of your Certificate of Title)
Landowner Consent Form
(refer to Section 9).                  Local Council (attach the completed Landowner Consent Form)
                                       Other (attach the completed Landowner Consent Form)

If applicable, provide with        21. Are you affiliated with a peak body? (e.g. State or National Association)
your application a completed
Peak Body Support Form
(section 11)
                                       YES     (attach the completed Peak Body Support Form)

                                       NO

Advice Notes                       SECTION 5 – PROJECT APPROVAL & MANAGEMENT
Please note: priority may be
given to projects that have        22. Do you have Development Approval for your project from your
obtained all development               local council?
permits/approvals required to
commence the project.                  Yes – received (attach a copy of approval)
If development approval is             No – lodged and awaiting decision (attach a copy of lodgement form)
not required, provide a letter
of verification from the               No – required, but not yet lodged
Planning Section, or
equivalent of your local               Not required (attach a letter of verification from your local council)
council.

Refer Child Protection Act         23. Have you undertaken a child safe risk assessment for the project?
and Facility Design section
of the Guidelines.
                                       Yes (complete question below)
Please note if you ticked no
and your project is                    No
successful, you may be
required to undertake a child          Not applicable to this project
safe risk assessment on
your project as a condition of
your grant agreement.              If yes, please list the key risks identified and what design feature you
                                   will include in the project to address the risk (If more space is required,
                                   please attach a separate sheet using the same headings as belo w)

                                   Risk                                 Design feature to address risk




                                                                                                Page Number:
                                24. Who will be managing the project?
                                   Our organisation will manage the project
                                   Our local council will manage the project (provide details below)
                                   Other (provide details below)


                                Contact Person           Name of organisation     Contact phone
                                                                                  number



Have you/will you establish a   25. What do you expect will be the annual maintenance/cyclical
sinking fund for example, or        replacement cost of the project over the next 10-years? How will
by registering with the
Australian Sports                   you fund this cost?
Foundation.




                                                                                     Page Number:
Advice Notes                     SECTION 6 – PROJECT COST

                                 26. Using the headings in the table below, outline the cost of your
                                     project
                                    Do not include cents – round up to the next dollar
                                    If your organisation is GST registered costs are to be GST exclusive.
                                    If your organisation is not GST registered cost are to be GST inclusive
                                    It is strongly recommended that applicants seek independent legal and financial
                                     advice to determine all taxation obligations before submitting an application.
                                    Costs are to be separated into cash items (A), and the total of in-kind support (B)
                                    If more space is required, attach a separate sheet using the same headings as
                                     below.



                                 PROJECT EXPENDITURE

Quotes to support the cost of                                                                                Appendix
                                 (A) CASH ITEMS                             Amount         Quote used
the project are to be provided                                                                                number
with your application.
                                 e.g. surfacing of courts               $100,000       See B&S              App no.5
You should be aware that
some landowners do not                                                                 courts’R’us quote
allow unlicensed
tradespersons/unskilled                                                 $
volunteers to work on
building projects; it is your                                           $
responsibility to clarify this
before lodging your                                                     $
application.
If you have donations,                                                  $
please provide signed letters
of commitment from donors.                                              $
In-kind qualified professional
labour costing should be
                                                                        $
based on a ‘reasonable’
commercial rate.                                                        $
Confirmation of support in                                              $
the form of quotes/letters
must be provided.
                                                                        $
Non-qualified volunteer
labour should be based on a      (B) IN-KIND SUPPORT                        Amount        Confirmation is    Appendix
rate of approximately $20/hr.                                                               attached         number/s
Evidence of volunteer
support is to be provided        Total donated materials                $              YES       NO
using the Volunteer Support
Form provided in Section 12.     Total in-kind labour (qualified        $
                                 professional)                                         YES       NO

                                 Total in-kind labour (non-qualified    $              Complete the non-qualified
                                 volunteers)                                           Volunteer Support Form
                                                                                       provided (Section 12)


                                 TOTAL COST OF THE PROJECT:             $




                                                                                               Page Number:
Advice Notes                     SECTION 7 – PROJECT INCOME

                                 27. Using the headings in the table below, provide details of how your
                                     organisation will fund the project
                                     Do not include cents – round up to next dollar
                                     Income is to be GST exclusive.
                                     Income is to be separated into cash support (A), and in-kind support (B).
                                      Provide a summary of the total income (C).



                                 (A) CASH SUPPORT

The amount of funding you                                                         Amount        Evidence is         Appendix
                                 Income
are requesting cannot be                                                        (GST excl.)      attached            number
more than 50% of the total       How much Office for
project cost.                    Recreation and Sport funding                   $
Please note priority may be      are you asking for?
given to applicants that have
secured their portion of the     Funds at bank                                  $             YES       NO
project cost.
                                 Loan(s)                                        $             YES       NO

                                 Other State Govt Funding                       $             YES       NO
Examples of evidence to
provide:                         Federal Govt Funding                           $             YES       NO
If you have funds at bank;       Local Govt Funding / Landowner
show where these funds are                                                      $             YES       NO
                                 Cash Support
e.g. in your audited financial
accounts or a bank               Other                                          $             YES       NO
statement.
If you are relying on future         TOTAL (A) CASH SUPPORT:                    $
surplus revenue, then
provide evidence of at least
two years actual Profit and
Loss figures to show that the    (B) IN-KIND SUPPORT (must equal the total in-kind support amount provided in question 25)
projection is realistic and
attainable.                      In-kind Support                                                        Amount (GST excl.)
If you have grants from other
sources, show a letter from      Total Donated materials                                            $
each granter.
If you are fundraising, show     Total In-kind labour (qualified professionals)                     $
how you will achieve your
fundraising target, For          Total In-kind labour (non-qualified volunteers)                    $
example, by registering with
the Australian Sports                                      TOTAL (B) IN-KIND SUPPORT:               $
Foundation.



                                 (C) TOTAL PROJECT INCOME                                           Amount

                                 TOTAL (A) – CASH SUPPORT:                                          $

                                 TOTAL (B) – IN-KIND SUPPORT:                                       $
                                 TOTAL INCOME
                                                                                                    $
                                 (must equal cost of the project provide in question 25)




                                                                                                        Page Number:
SECTION 8 – APPLICANT DECLARATION

Final checklist before submitting your application
         We have completed all relevant sections of this application form
         We have attached all supporting material requested in this application form.

Instructions
1. The declaration below must be read and signed by two authorised representatives of your organisation
2. At least one representative must be a member of the Board / Management Committee.


Declaration by authorised persons
I make the following declaration:
1. I am duly authorised by the organisation to prepare and submit this application
2. This organisation is eligible to apply for funding in accordance with the eligibility criteria in the Funding
   Guidelines
3. The responses in this application and all supporting documents provided are to the best of my knowledge true
   and correct
4. I understand that the Office for Recreation and Sport may disclose the information provided in this application to
   other Government agencies, Local Government, Peak Bodies, reviewers and staff assisting with the
   administration or promotion of State Government Grant Schemes
5. I understand that information in relation to this project will be made public in the event that the application for
   funding is successful
6. The project will not benefit any organisation that holds a Gaming Machine License issued under the Gaming
   Machines Act, 1992
7. Where required, our project will comply with all the relevant building codes, standards and applicable legislation
   including, but not limited to, the Disability Discrimination Act and the Children’s Protection Act 1993.


        Signature 1:                                            Signature 2:
                 Date:                                                    Date:
               Name:                                                      Name:
            Position:                                               Position:


Please forward this completed application and all attachments to:

BY POST:                                                    IN PERSON:
Applications post marked on or before the                   Hand delivered applications must be received by
closing time and date will be accepted.                     5.15pm Monday 30 April 2012
        Community Recreation and Sport                      Community Recreation and Sport Facilities Program
        Facilities Program
                                                                    Office for Recreation and Sport
        Office for Recreation and Sport
                                                                    27 Valetta Road
        PO Box 219
                                                                    KIDMAN PARK SA 5025
        BROOKLYN PARK SA 5032

            LATE APPLICATIONS MAY NOT BE ELIGIBLE FOR FUNDING CONSIDERATION

           Applications close 5:15pm Monday 30 April 2012
                           Telephone: (08) 7424 7708            Web: recsport.sa.gov.au
                                                                      H                   UH




                 It is anticipated that applicants will be notified of the outcome by July 2012



                                                                                               Page Number:
SECTION 9 – LANDOWNER CONSENT FORM

Please contact a Funding Consultant on (08) 7424 7708 if you have any questions regarding this
form.
A WORD version of the form can be downloaded from the Office for Recreation and Sport website:
http://www.recsport.sa.gov.au



In relation to the grant application from:
                                       (name of applicant)

                     For the following project:
                                            (project name)

                            To be undertaken at:
                                          (facility address)



                    The property is owned by:

                                  Land Title Status               Operational    Community
     (only to be completed where land owner is the Council)



The applicant’s arrangement with the landowner is:

    Leaseholder                                                 Expiry date of lease:

    Seasonal Permit Holder (re-negotiated annually)

    Permanent Seasonal Permit Holder                           Expiry date of permit:


As landowner, we give consent for the project and in addition we will be providing the
following support:

    Other than consent, no other support is provided

    Financial Support                                                       Amount: $

    In-kind support (please provide details below)


Type of in-kind support                                                                 Value

                                                                                        $

                                                                                        $

                                                                                            Page Number:
Are there any conditions attached to this support? (please list e.g. funding is subject to
following years budget being approved etc)




As landowner we have the following requirements for any work undertaken (please list e.g.
only licensed tradespersons will be permitted to undertake work on this site, owner will project
manage works undertaken, etc)




Other comments (e.g. the project has been identified by the owner as a high priority )




Authorisation
I am authorised to complete this document on behalf of the landowner

Signed:

Name of signatory:

Position held:

Contact Number:       Phone (wk):                            (mb):




                                                                            Page Number:
SECTION 10 – COUNCIL SUPPORT FORM


This form is only to be completed where the Council is not the landowner
Please contact a Funding Consultant on (08) 7424 7708 if you have any questions regarding this
form.
A WORD version of the form can be downloaded from the Office for Recreation and Sport website:
http://www.recsport.sa.gov.au



In relation to the grant application from:
                                  (name of applicant)

                    For the following project:
                                       (project name)

                         To be undertaken at:
                                     (facility address)


As the applicant organisation’s Council; are you providing either of the following?


    Financial Support                                                Amount: $

    In-kind support (please provide details below)


Type of in-kind support                                                           Value

                                                                                  $

                                                                                  $

                                                                                  $


Are there any conditions attached to this support? (please list e.g. funding is subject to
following years budget being approved etc)




                                                                                       Page Number:
Other comments (e.g. the project has been identified by the owner as a high priority )




Authorisation
I am authorised to complete this document on behalf of the Council

Signed:

Name of signatory:

Position held:

Council:

Contact Number:       Phone (wk):                            (mb):




                                                                            Page Number:
SECTION 11 – PEAK BODY SUPPORT FORM


This document is not considered essential, however it is recommended you communicate with
your Peak Body about your project.
Please contact a Funding Consultant on (08) 7424 7708 if you have any questions regarding this
form.
A WORD version of the form can be downloaded from the Office for Recreation and Sport website:
http://www.recsport.sa.gov.au/funding-scholarships/community-recreation.html



In relation to the grant application from:
                                  (name of applicant)

                    For the following project:
                                       (project name)

                         To be undertaken at:
                                     (facility address)


As the applicant organisation’s Peak Body; are you providing either of the following?


    Financial Support                                                Amount: $

    In-kind support (please provide details below)


Type of in-kind support                                                           Value

                                                                                  $

                                                                                  $

                                                                                  $


Are there any conditions attached to this support? (please list e.g. funding is subject to
following years budget being approved etc)




                                                                                       Page Number:
Other comments (e.g. the project has been identified by the owner as a high priority )




Authorisation
I am authorised to complete this document on behalf of the Peak Body

Signed:

Name of signatory:

Position held:

Peak Body:

Contact Number:       Phone (wk):                            (mb):




                                                                            Page Number:
SECTION 12 – NON-QUALIFIED VOLUNTEER SUPPORT FORM
   Complete this attachment if you have included non-qualified volunteer labour in your total project cost (refer
    question 25)
   The total volunteer labour cost MUST equal the total in-kind labour (non-qualified volunteers) figure given in
    question 25
   Suggested volunteer labour rates is $20/hr.

                                                         Number of    Hours            Rate per         Total
Task Performed
                                                         People       Required         Hour             Amount

e.g. Removal of rubbish / preparing new site for works   2            3 hours          $20.00           $120

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                                        $

                                                                                       TOTAL:           $




                                                                                             Page Number:

								
To top