2013 CGP Application Form Electronic Application by 4kGN8IE

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                     2013 HUME COMMUNITY
                     GRANTS PROGRAM
                     APPLICATION

    SECTION 1: Applicant Contact Details
     1. The Name of organisation or group applying for funds (applicant):



     2. Applicant Postal Address:

        Suburb:                                                                   Postcode:

     3. Applicant Phone B/H:

     4. Applicant Web Address:

     5. Applicant Email Address:

     6. How long has the applicant
        existed?


     7. Is the applicant not-for-profit?         Yes        No -The applicant is not eligible to apply for a grant

     8. Is the applicant incorporated?
              Yes – What is the Applicant’s Registration Number?

                                                                        Attach copy of Incorporation Registration

              No – Did the applicant or an auspice receive 2012 Hume Community Grants funding?

                     Yes, 2012 Grant recipients must be incorporated to be eligible for future funding
                           The applicant is not eligible to apply for a grant
                     No,   an unincorporated applicant is eligible to apply for a ‘once-off’ Grant
                           provided the group did not receive 2012 Council Community Grant Funding
                            If successful, the applicant must be incorporated to be eligible for future funding
     9. Do you have an auspice organisation?
              Yes – please complete section 2 questions 10 - 16
              No – please go to section 3 questions 17- 22

    OFFICE USE ONLY
     CA Inn Pt1 Pt2 $




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    SECTION 2: Details of Auspice/Support Organisation                                                (if applicable)

    10.Auspice Name:



    11. Auspice Postal Address:

       Suburb:                                                                        Postcode:

    12. Auspice Phone B/H:

    13. Auspice Web Address:

    14. Auspice Email Address:

    15. Is the auspice not-for-profit?

               Yes           No -The auspice must be not-for-profit to be eligible to apply

    16. What is the auspice’s Incorporation Registration Number?
                                                                           Attach copy of Incorporation Registration

      The auspice must co-sign the application and if successful, any funds will be paid to the auspice.



    SECTION 3: Applicant’s Authorised Contact Person
This is the person authorised to answer questions about your application. It is important that Council be able
to reach this person within one business day if required.

    17. Contact Title:           Mr          Mrs         Ms         Miss         Dr          Other

    18. Contact Name:

    19. Contact Position within the group/organisation:

    20. Contact Phone B/H:                                     21. Contact Mobile:

    22. Contact Email address:


    SECTION 4: Taxation and Banking Information
    23. Does the applicant/auspice have an ABN Australian Business Number?
               Yes – What is the ABN?                                    Attach a copy of current ABN Registration

               No – Attach a Statement by supplier form– please see page 14 of the Grant Information Kit

    24. Is the applicant/auspice GST Registered?
               Yes, If successful you will be required to submit a tax invoice               No

    25. What is the applicants’/auspices’ Official Bank Account Name? This is the bank account name and
        not the BSB or bank account number, any funds granted will be paid into this account.



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    SECTION 5: Your Group or Organisation
    26. What does your organisation or group do?
    Briefly describe its purpose, general activities, details of where and how often you meet etc.




     27. Have you attached a copy of your last Annual Financial Report?                                 Yes              No

     28. Have you attached a copy of the applicant’s most recent Income and Expenditure Statement?

                                                                                                        Yes              No


    29. Have you attached a copy of the applicant’s bank statement or official document that shows
        the applicant’s current position?                                                               Yes              No

    30. If you answered No to questions 27 to 29, please provide information about the applicant’s
        financial position.




    31. How do you raise income to assist with the cost of your activities or services?

        Do you charge a contribution?                      Yes       How much?

                                                           No

        Other, please detail:

    32. Do you currently receive any funding or in kind support from Hume City Council?

        Funding 2012 Community Grant?                                Yes                No

        Other funding please describe:

        Other in-kind please describe:

         Use of a room/facility at community rate                    Yes                No


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    SECTION 6 : Grant Proposal
    33. What type of grant are you applying for?
                Community Activity Grant                     Innovation
                Partnership Grant – Tier 1                   Partnership Grant – Tier 2

    Please note: If eligible, you may apply for up two grants either a Community Activity or Innovation
      Grant and/or a Partnership Grant, either Tier 1 or Tier 2.
    If you choose to apply for 2 grants you must complete and lodge a separate application for each.

    34. Have you discussed your proposal with a Council Officer?                 Yes             No              N/A

    35. If yes, below please name which Council officer you discussed your proposal with:



    36. What is the name of your community grant activity or proposal?



    37. Where in Hume will the project be delivered?
        Attwood                Craigieburn               Kalkallo                      Roxburgh Park

        Bulla                  Dallas                    Keilor                        Somerton

        Broadmeadows           Diggers Rest              Meadow Heights                Sunbury

        Campbellfield          Gladstone Park            Melbourne Airport             Tullamarine

        Clarkefield            Greenvale                 Mickleham                     Westmeadows

        Coolaroo               Jacana                    Oaklands Junction             Yuroke

        At various locations across Hume City

        Other, below please state where and explain why it is to occur outside Hume.




     38. How many people do you expect will join in the activity or project?

     39. How many people from Hume will join in the activity or project?

     40. How will you promote your activity or project?
        The applicant is listed in the Community              Referral i.e. by Neighbourhood, Community
        Directory – Hume City Council’s Website               House &/or Health Centres
        Advertise in local community papers                   Flyers, mail outs / mail drops

        Advertise on local community radio                    Newsletter, local school etc

        Other, below please describe                          Word of mouth




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    SECTION 6: Grant Proposal (cont’d)
Before answering question 41, it is important that you read and understand the section entitled, How
will the Grant Application be assessed on page 10 of the 2013 Community Grants Information Kit

    41. Why is the project needed?                                                    30% Weighting
       Ensure your application:
         Explains the need or issue that the application seeks to address
         Is supported by data and information
         Is informed by local knowledge
         Is consistent with Council’s Vision and Council Plans




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    SECTION 6: Grant Proposal (cont’d)

Before answering question 42 it is important that you read and understand the section entitled How
will the Grant Application be assessed on page 10 of the 2013 Community Grants Information Kit

    42. What will the project achieve?                                                 20% Weighting
       Ensure your application:
         Describes the purpose of the activity
         Explains the anticipated outcomes or benefits for Hume City
         Describes any products that will be developed (e.g. project report, study, DVD etc) or what
           activity will take place (e.g. your group becoming incorporated or organising training for
           volunteers etc.)
         Explains how the product or benefits will be sustained once the funding from Hume City
           Council ceases (not required for Community Activity Grant Applications)




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    SECTION 6: Grant Proposal (cont’d)

Before answering question 43 it is important that you read and understand the section entitled How
will the Grant Application be assessed on page 10 of the 2013 Community Grants Information Kit

    43. Who is involved in the delivery of the project?                              20% Weighting
       Ensure your application:
         Is from an organisation based in Hume City and/or demonstrates strong community
           connections with Hume City
         Explains how representatives from Hume City communities and stakeholders will be
           involved in the project




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SECTION 6 : Grant Proposal (cont’d)

Before answering question 44 it is important that you read and understand the section entitled How
will the Grant Application be assessed on page 10 of the 2013 Community Grants Information Kit

    44. How will the project be delivered?                                           30% Weighting
       Ensure your application:
         Demonstrates experience and ability to manage the amount of grant money sought
         Budget reflects the scope and timeframes for the delivery of the proposal
         Outlines the steps in which the project will be implemented




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SECTION 6 : Grant Proposal (cont’d)

The following space is for the use of Innovation and Partnership Grant Applicants only; to
provide further information in relation to question 44. How will the project be delivered?

    The application must demonstrate:
          That complex proposals will be managed by a project management group with the ability
           to source the required expertise for the project
          Ability to attract external resources and support to enable the project to be sustainable
           over time
          A method and measures to evaluate the proposal’s processes and/or outcomes
          Provide evidence of ability to provide co-funding contribution (Partnership Tier 2 Only)




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     SECTION 6 : Grant Proposal (cont’d)
    45. How much money are you requesting from Council to help you deliver the project? $

    46. Will the project go ahead if you do not get the full amount requested from Council?
                Yes          No
    47. What is the minimum contribution required to permit the project to go ahead?                  $

    48. Your Budget - please assist Council to understand your plans by providing the following
          information:
    Income                                         $     Expenditure                                              $

    Funds from your organisation                         Staffing exclude on-costs here
    In kind Support from your organisation               On-costs (Based on          %)
                            e.g. Volunteer Work
                   (Based on $         per hour)         Venue Hire
    In kind support other than Volunteer Work
    — please list:                                       Small Equipment Purchases
                                                         Equipment Hire
                                                         Telephone
                                                         Postage
    Fundraising or donations from business
    sources                                              Stationery
    Local Government Funding— Other than
    Hume City                                            Printing
    State Government Funding                             Advertising
    Other Income e.g. Fees & Charges
    Please provide details                               Travel Expenses
                                                         Other Expenses – please list



    Amount requested from Council’s Grant
            Proposal’s Total Budget Income                   Proposal’s Total Budget Expenditure
      Proposal Summary
     What is the total cost of your proposal?                                                  $
     How much is Council being asked to contribute to your proposal?                           $
     What other funds have been granted for your proposal?                                     $
     What is the Net Cost to you—your contribution?                                            $

    49. Have you applied for and/or received funding from other groups or organisations to support
        the project outlined in this Grant Application?         Yes            No, please go to question 50


                                                          Has this money been           If outcome is not known at
    Organisation’s Name?                      How much
                                                               received?                this time write ‘unknown’
                                                              Yes          No
                                                               Yes               No
                                                               Yes               No


    50. When will the project be undertaken? Start Date:                        Completion Date:


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SECTION 7 : Referee’s and Privacy Statement


Please supply the name of a least one other organisation or community group that is able to provide
information about your group/organisation and the activities that you conduct.

Please note: Councillors and Council staff are unable to be referees as this could be a perceived
conflict of interest.
Details 1st – Nominated Referee

    Referee’s Name:

    Referee’s Position:

    Referee’s Phone B/H:

    Referee’s Mobile:

    Referee’s Email Address:


Details 2nd – Nominated Referee

    Referee’s Name:

    Referee’s Position:

    Referee’s Phone B/H:

    Referee’s Mobile:

    Referee’s Email Address:




     Privacy Statement
      Council is collecting the personal information on this form for the purpose of enabling you
      to participate in the Hume City Council Community Grants Program. This information will
      be disclosed to members of Council’s Community Grants Assessment Panel and not to any
      other party except as required by law. If you fail to provide this information, Council cannot
      consider your application under the Community Grants Program. You may access this
      information by contacting Council on 9205 2200.




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SECTION 8 : Declaration

By signing this Application we agree that:

    1. All of the information we give to Council is relation to the grant and application is true and
       correct, whether that information is given through this application or in any other way.

    2. The persons signing this form are authorised by the applicant/auspice organisation to act on
       behalf of the applicant/auspice.

    3. The person named as the Contact Person in this Application has the authority to provide any
       information that may be required by Council in relation to this application.

    4. If we receive a grant, we will do the following things as part of our agreement with Council in
       relation to the grant:
        a. Attend the Community Grants Awards Presentation Evening on Tuesday 12 February 2012.
            We understand that if we do not have a representative present at the Ceremony we may be
            disqualified from receiving a grant.
         b. Spend the money for the project for which the grant was provided, as described in
            Council’s notification letter.
         c. Return all unspent funds to the Council.
         d. Accept that the Council reserves the right to request and review the applicant’s financial
            documentation to verify the information provided to Council and other funding sources.
         e. Prominently acknowledge Council’s support in any advertisements, flyers or other
            communication used to tell people about the activity or project. (Council can provide
            examples or standard wording).
         f. Provide the following documents to Council for each year funded:
                      i. Progress Report by 30 May, and
                     ii. Final Accountability Report by 30 November.
         g. Include any GST payment received from Council in our quarterly Business Activity
             Statement.

    5. We understand that:
         a. If we do not act in accordance with this agreement we may not be eligible for any further
            grants from Hume City Council.
         b. Council may impose any special conditions as part of the agreement.

    6. We understand the we alone and not Hume City Council have responsibility for the activity or
       project and for the care and safety of all those people who take part in, or are affected by, the
       project.

Signed On Behalf of the Applicant/Auspice by its Duly Authorised Representative/s:

_______________________________                            _____________________________
Please Sign Here                                           Contact Person Please Sign Here

_______________________________                            _____________________________
Name (Please Print)                                        Name (Please Print)

______________________________                             _____________________________
Office/Authority                                           Office/Authority
______________________________                             _____________________________
Date                                                       Date


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