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Application Form for McDonalds

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Application Form for McDonalds Powered By Docstoc
					APPLICATION
FORM
                                                                    An initiative of the McDonald’s Restaurants in the Brisbane and Greater Brisbane Area




Applicants should read the Funding Guidelines carefully before completing this Application Form. For full details please
refer to the website www.mcdonalds.com.au/MBCTF.
Please answer each question fully and submit 4 copies of requested documents with the Application Form.
This original Application Form must be fully completed and submitted along with your written Funding Submission
and any other required documentation to: PO Box 3357, Stafford Delivery Centre, QLD 4030.
Incomplete or faxed copies will not be considered for funding.

     APPLICATION DEADLINE: 31 MARCH, 30 JUNE, 30 SEPTEMBER AND 31 DECEMBER 2005

 PERSONAL INFORMATION

Name: _____________________________________________________________________________________________________
(Circle):    Mr     Miss     Ms     Mrs    Other designation:
Address: ___________________________________________________________________________________________________
 __________________________________________________________ Post Code: ______________________________________
Telephone: (      ) ___________________________________________________________________________________________
Applicants must demonstrate that they fall within the eligibility criteria as outlined in the Funding Guidelines.


 ORGANISATION DETAILS (Applicant)

Name of Organisation or Individual: _____________________________________________________________________________
Postal Address: _____________________________________________________________________________________________
 __________________________________________________________ Post Code: ______________________________________
Telephone: (      ) ___________________________________________________________________________________________
E-Mail Address: _____________________________________________________________________________________________
ABN: _____________________________________________                 GST Registered:                      Yes                No
                                                                Income Tax Exempt:                      Yes                No

 CONTACT PERSON (For enquiries during business hours regarding this application)

Full Name: _________________________________________________________________________________________________
Address: ___________________________________________________________________________________________________
 __________________________________________________________ Post Code: ______________________________________
Telephone – Business Hours: (       ) ____________________________________________________________________________
E-Mail Address: _____________________________________________________________________________________________

 ACCOUNTABLE OFFICER

The accountable officer is the President or Chairman of the Management Committee.
Name: __________________________________________ Position in organization: ______________________________________
Postal Address: _____________________________________________________________________________________________
 __________________________________________________________ Post Code: ______________________________________
Telephone – Business Hours: (       ) ____________________________________________________________________________
E-Mail Address: _____________________________________________________________________________________________
  STATE THE PURPOSE FOR WHICH YOU ARE SEEKING FUNDS – One Sentence

_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

  BUDGET

Please list items in priority order, each item should be listed and costed individually.
A copy of the selected quotation for each item listed must be attached.

Budget Item                                                             Total Cost ($)                     Total Cost less GST ($)
 __________________________________________________________________________________________________________
 __________________________________________________________________________________________________________
 __________________________________________________________________________________________________________
TOTAL PROJECT COST _______________________________________________________________________________________
Less: Organisation’s contribution to project (if applicable) ____________________________________________________
Less: Funds to be raised (where applicable)__________________________________________________________________


TOTAL GRANT SOUGHT _____________________________________________________________________________________

I certify that the information provided in this application is, to the best of my knowledge, true and complete, and that it accurately
reflects the financial position of the proposal. I authorise the release of the information contained herein to the appropriate Selection
Committee being the Board of Trustees and I authorise the Board of Trustees to make further enquires where necessary. In addition,
I agree to include details of this project to be utilized in external marketing or publications eg. media releases and website.


Date: ____________________ Applicant’s signature: _______________________________________________________

  FINANCIAL AND LEGAL DOCUMENTS

Please attach (4) copies of the documents in this order:
       Application Form – all copies to have original signatures
       Funding Submission – 200 word outline of your proposal as a separate attachment
       Certificate of Incorporation
       List of current Management Committee, Board or similar
       Statement by Supplier – where an organisation does not have an ABN
       Latest Audited Financial Statement for the organisation
       Quotations
       Copy of plans/drawings (if applicable)

OTHER COMMENTS: _________________________________________________________________________________________
 __________________________________________________________________________________________________________
 __________________________________________________________________________________________________________
 __________________________________________________________________________________________________________

Name: (please print) _________________________________________________________________________________________
Address: ___________________________________________________________________________________________________
 __________________________________________________________ Post Code: ______________________________________
Telephone: (     ) ____________________________________________ Fax: (               ) ______________________________________
Date: ________________________________ Signature: ___________________________________________________________

				
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