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Community Services Grants Glen Eira City Council

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					                     Glen Eira City Council

                     Community Services Grants 2013–2014
   Application form
                Applications close                             5pm Friday 26 April 2013

                Return completed forms to                      Community Service Grants Application
                                                               Glen Eira City Council
                                                               PO Box 42
                                                               Caulfield South 3162

   Part 1: Applicant details
   You must complete each part and include attachments where required.
   Incomplete applications will not be considered.

   Name of organisation:

   Street address:

   Mailing address:


   Who should we contact if we have a question about this application?

   Name:

   Position title:

   Business hours telephone:

   Mobile:

   Email:
   Facsimile:


   Please give a brief summary of the proposed program/project:




   How much are you applying for? (up to $7,500)                                          $


   Please tick the relevant box below to specify the type of assistance applied for. (You may tick more than one box)
             Public health and wellbeing           Families, children and youth            Sport and recreation
             Active seniors                        Environmental sustainabiity             Arts and culture project

             Other — please specify:

Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 1
                  Glen Eira City Council

                  Community Service Grants 2013–2014
   Part 2: Incorporation/financial details
   Note: If your organisation is not incorporated, the maximum amount you can apply for is $1,000.
   Unincorporated organisations wishing to apply for more than this amount can arrange for a legally
   constituted organisation, as an auspice organisation, to manage any grant funds.




   Each question below must be answered or the application cannot be processed.

   1.   Is your organisation incorporated?          Yes           Incorporation number:
                                                    No            If no, complete Attachment B: Auspice Organisation



   2.   Does your organisation have an ABN?         Yes           ABN number:
                                                    No            If no, complete Attachment B Auspice Organisation


   3.   Is your organisation a not-for-profit entity? Yes
                                                     No           If no, complete Attachment B Auspice Organisation


   4.   Does your organisation carry public          Yes          If yes, please state the amount of cover, and provide
        liability insurance?                                      a copy of the certificate $

                                                     No           If no, complete Attachment B Auspice Organisation


   5.   Is your organisation registered for GST? That is, does your organisation submit a quarterly
        Business Activity Statement (BAS) to the Australian Taxation Office (ATO)?                Yes            No

   6.   Does your organisation hold Deductible Gift Recipient status?                            Yes             No

   7.   Is your organisation endorsed as a tax concession charity?                               Yes              No

   8.   What fees are paid each year per member?                                     $


   9.   How much money is in your organisation’s bank account as at 1 March?         $

   10. Approximate annual operating budget for your organisation:

        Less than $10,000         $10,000–$20,000           $20,000–$50,000        $50,000–$100,000        $100,000 +


                                   Attachments to include for Part 2
              1. A copy of your Public Liability Insurance Certificate.
              2. The last financial report covering a full year.
              3. Most recent monthly financial/bank statement(s).
              4. A copy of your most recent Annual Report (if one is produced by your organisation).


Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 2
                    Glen Eira City Council

                    Community Service Grants 2013–2014
   Part 3: Organisation details
   1.   What are your organisation’s aims and objectives?
        1.
        2.
        3.
   2.   Is your organisation open to all residents of Glen Eira?      Yes              No
        If no, what membership restrictions apply? (Number and list restrictions)



   3.   What is the focus of your organisation? (You may tick more than one box)
          Children                          Seniors                       Women                                  Men
          Disability                        Family                        Social activities                      Education
          Faith and/or interfaith           Arts and culture              Youth
          Support/self-help                 Health                        Sporting/recreation programs
   4.   Number of active members or service users in your organisation:
   5.   Number of Glen Eira members/service users in your organisation:
   6.   Have you previously received a community grant from Glen Eira City Council?                  Yes          No
        If yes, please give details of grants received over the past three years. If you did not receive a grant for a
        particular year, write ‘None’ under Grant amount.
           Year           Grant amount                                     Purpose
        2012–13
        2011–12
        2010–11
   7.   What other (non-Council) funding has your organisation received over the past financial year?
                                          Funding body                                       Amount granted




   8.   Is your group applying for a buildings and works grant?                             Yes             No
        (If yes, please answer the following questions. If no, go to Part 4)
        8a. Does your organisation use a Council facility or building?                      Yes             No
        8b. Is the building located on Council-owned land?                                  Yes             No
        8c. Does Council maintain the property or building?                                 Yes             No
        If yes to any of the above please provide address of building or facility:


   Note: Tenants of Council properties seeking a grant for buildings and works must first seek landlord consent
   and/or approval before submitting a grant application. Such Council support should be in the form of a letter
   attached to your application.

   9.   Please provide contact details of your organisation’s Committee of Management.
        President                 Name                                                      Phone number
                                  Address
        Secretary/Public Officer Name                                                     Phone number
                                  Address

Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 3
                  Glen Eira City Council

                  Community Service Grants 2013–2014
   Part 4: Details of assistance request
   Please tell us about your proposed program/project — What you are doing? Who are you doing it for? Why is it
   important?

   1.   Title of Program/Project

   2.   What will you be doing?




   3.   Which, if any, of the following Council high priorities will your program/project be addressing? If you are unable
        to tick a box, your application will not be precluded from the application process.
        (You may tick more than one box)
            minimise social isolation and promote community involvement;
            new service that improves levels of community safety;
            promote access to services for children of all-abilities;
            promote physical activity, play and community connectedness;
            encourage volunteering and recruit volunteers to provide services to the community;
            inclusive of all, have an open membership and provide a benefit to a broad range and number of Glen Eira
            residents;
            community celebrations that acknowledge diversity and are inclusive and accessible for all members of the
            community;
            recreation and leisure activities that improve community wellbeing;
            arts and cultural activities that encourage community participation;
            health education programs that improve community wellbeing by addressing childhood obesity, falls
            prevention, mental health, domestic violence, drug and alcohol abuse and problem gambling;
           target graffiti prevention or removal;
           work actively with the community to protect or improve the natural environment for current and future
            generations;
            support access for all-abilities;
            programs that encourage community harmony and tolerance; and/or
            provide intergenerational contact between the young and aged population groups.

   4.   Who is the target group? (Tick all that apply)
          Children                    People with a disability               Women
          Youth                       Indigenous people                       Men
          Families                    Culturally and linguistically diverse communities
          Seniors                     Other (please specify)

   5. Total number of individuals to benefit:                        Number of Glen Eira residents:


   6.   What will the program/project achieve? (Number and list expected outcomes)




Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 4
                  Glen Eira City Council

                  Community Service Grants 2013–2014
   7.   What community need(s) will this program/project address and how have these been identified?




   8.   When is the project start date?                                 Finish date?


   9.   What is the estimated cost of the project?                      $


   10. How much are you requesting from Council? (Up to $7,500)        $


   11. How much will the organisation contribute to the project?       $


   12. Have you sought funding for the proposed project elsewhere?          Yes        No

   13. Will you be receiving funding from any other source in relation to the proposed project?       Yes     No
        If yes, please provide details:

                                          Funding body                                       Amount granted




   Further information
   14. Is there any further information that will support your application? (Detail below)




Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 5
                  Glen Eira City Council

                  Community Service Grants 2013–2014
   Part 5: Proposed project budget
   Provide a detailed breakdown of the project budget.

   Note: If you plan to hire a Council facility as part of your grant application, you must complete both this section and
   Attachment A. If facility hire makes up the whole of your grant application, skip this section and go straight to
   Attachment A.
                              Expenditure                                    Amount ($)              Council ($)




    TOTAL

                                  Income                                     Amount ($)




    TOTAL
    AMOUNT SOUGHT FROM COUNCIL IN THE APPLICATION
    TOTAL INCOME

    Notes:
    • Yellow column figures should be expenditure sought from Council funding.
    • Additional spreadsheets can be attached as part of the application support material.
    • The total of all separate budgets should equal the amount requested in Part 1 of this application.
    • Your budget must include all projected income (case and in-kind) and all costs.

   1.   Will the grant be used to purchase works, items or equipment costing more than $500? Yes             No
        If yes, please provide three quotes for each item along with this application.
   2.   If your application involves both a project and Council facility hire, how much of the grant is
        required for each component?
        Facility hire amount: $                                 Project amount: $

                                        Attachments to include for Part 5
               Three quotes — if applying for works, items or equipment costing more than $500.


Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 6
                    Glen Eira City Council

                    Community Service Grants 2013–2014
   Part 6: Declaration
   “I certify:
       •     I am authorised as the President or Secretary of the organisation to make this application for a community
             grant and sign this document;
       •     the information provided is true and correct and an accurate representation of the organisation’s
             status; and
       •     I acknowledge that any material misstatement may invalidate the application and any grant given making the
             organisation liable to repay the grant.”


   Signed:                                                                   Date:

   Print name:

   Organisation:

   Position:


   Information privacy
   The personal information on this form is required by Council for the purpose of allocating community grants in
   a fair and transparent manner. Failure to provide this information may mean that the application for a community
   grant cannot be accepted. All information provided (with the exception of individuals’ personal information) may be
   inspected by and/or made available to members of the public. For more information about privacy at Glen Eira City
   Council, including the right to seek access to the information collected on these application forms, please contact
   Council’s privacy officer on 9524 3333.




Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 7
                  Glen Eira City Council

                  Community Service Grants 2013–2014
   Attachment A: Facility hire
   Complete this section only if your group is applying for funding for use of Council facilities as the whole or part of
   your grant application.
             Facility/room requested                 Proposed useage date and time                      Cost




                                                                               Total cost $


   Council facilities and booking contact names:
   Carnegie Library and Community Centre                          Public halls
   (Contact: Nick Corrigan)                                       (Contact: Denise Stavridis)

   • Boyd Room                                                    • Bentleigh Recreation Reserve Social Room
   • Carnegie Children’s Multi-purpose centre                     • Bentleigh/McKinnon Youth Centre
                                                                  • Caulfield Park Pavilion Community Room
   Glen Eira Town Hall                                            • Caulfield Park Pavilion Meeting Room
   (Contact: Nick Corrigan)                                       • DC Bricker Pavilion
                                                                  • Duncan Mackinnon Reserve
   • Auditorium (and kitchen)                                     • East Caulfield Reserve Social Room
   • Caulfield Cup Room (and kitchen)                             • Glen Huntly Park Function Room
   • Labassa Room                                                 • McKinnon Public Hall
   • Ogaki Room                                                   • McKinnon Reserve Social Room
   • Rippon Lea Room                                              • Moorleigh Community Village Meeting Rooms
   • Theatrette                                                   • Moorleigh Social Room
   • Yarra Yarra Room                                             • Murrumbeena Hall
                                                                  • Packer Park Hall


   Please note:
   • Groups need to make their own bookings.
   • Groups need to contact Council before applying for facility hire assistance to determine costs and availability.
   • Payment for facility hire will be made by Council internal transfer.




Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 8
                      Glen Eira City Council

                      Community Service Grants 2013–2014
   Attachment B: Auspice organisation
   This section must be completed by the auspice organisation.

   Name of organisation:

   Street address:

   Mailing address:

   Name of authorised person:

   Position title:

   Business hours telephone:

   Mobile:

   Email:

   Facsimile:


   1.   Incorporation number:


   2.   Does your organisation have an ABN?                                                        Yes            No

                                                              ABN number:

   3.   Is your organisation registered for GST? That is, does your organisation submit a quarterly
        Business Activity Statement (BAS) to the Australian Taxation Office (ATO?)                  Yes           No


   4.   Does your organisation hold Deductible Gift Recipient status?                              Yes            No

   5.   Is your organisation endorsed as a tax concession charity?                                 Yes            No


   6.   Approximate annual operating budget for your organisation:


        Less than $10,000           $10,000–$20,000        $20,000–$50,000        $50,000–$100,000        $100,000 +



                                                  Attachments to include
                     1. A letter stating you support the proposed project and are willing to manage the
                        funds on the applicant’s behalf.
                     2. Copy of your current incorporation certificate.



Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 9
                   Glen Eira City Council

                   Community Service Grants 2013–2014
    Application checklist
    Before you submit your application, please complete the following checklist to ensure you have done all you need to
    complete the application.

    Incomplete applications cannot be processed.

    Please tick:

          All questions have been answered.

          Your application has been submitted on the approved form.

          The following copies have been attached:

          •    Public Liability Insurance Certificate;
          •    the organisation’s most recent annual financial statement;
          •    the organisation’s most recent monthly financial/bank statement(s);
          •    the organisation’s most recent annual report (if one is produced by your organisation);
          •    three quotes (for equipment or works costing more than $500);
          •    letter of support for buildings and works applications. (Council tenants only); and
          •    letter of support from auspicing organisation. (Non-incorporated organisations only).

          You have provided your:

          •    GST status;
          •    ABN number; and
          •    incorporation number.

          The declaration has been signed and dated by the president or secretary of the organisation.


          Groups that received community grant funding for 2012–2013 must submit the community grants reporting
          form to Council.

          You have made a copy of the application for your own records.




Bentleigh Bentleigh East Carnegie Caulfield Elsternwick Gardenvale Glen Huntly McKinnon Murrumbeena Ormond St Kilda East 10

				
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