Application for Grants

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GRANT APPLICATION FORM

Which category best applies to your proposed project?

If other - please specify

Applicant Organisation details

Name of Organisation

Main Street Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Australian Business Number (ABN)

Contact Person

This is the person who is authorised by the organisation to make the application on its behalf

First Name

Last Name

Position

Phone

(###)

###

####

Email Address

Project Overview

Project Name

Anticipated project start date

YYYY

Anticipated project completion date

YYYY

Total funds applied for?

PLEASE SPECIFY

Describe the aim of the program or initiatives you will deliver.

Describe the aim and nature of the program or the initiatives you will deliver.

Brief outline of your project proposal and expected outcomes?

What specific group/s in Eaglehawk will benefit? How many people will benefit from your project?

How will this project benefit the Eaglehawk Community? And how will you promote it to the Community?

How will your organisation/club support Empowering Eaglehawk Inc?

Other than meeting the initial criteria

What other funding sources have you sought?

Project Budget

Please provide details of the income and expenditure for your project, including GST. (Note that the total income should equal total expenditure)

Expenditure (GST Inclusive)

Provide details & costs ($) for: staffing expenses (wages), hire of facilities, equipment, operating expenses, consumables (supplies etc.), other expenses (please specify)

Total Project Cost

Income (GST Inclusive)

Provide detail & income ($) for: applicant contribution (Income provided by applicants or other funding bodies), other income (please specify)

Total Project Income

Total amount requested from Empowering Eaglehawk Inc.

Income minus Expenditure - (Up to $5000)

Please provide details of any in-kind contributions made by you, the organisation or partnership: (volunteers, use of facilities, use of equipment or supplies, transport, etc.)

Please detail for each: 1) In-kind contribution/resource. 2) Name of organisation providing donation, 3) Equivalent worth ($)

Application Checklist

I acknowledge that I am authorised to submit this application on behalf of the organisation

All relevant fields in the application have been completed and are correct

The proposed project produces positive outcomes for the Eaglehawk community

Necessary number of Referrals are complete to be submitted. - See checklist at the top of this page for details.

I agree to complete all necessary Grant Evaluation processes when required.

I state that the information in this application and attachments is to the best of my knowledge true and correct. I will notify EEI of any changes to this information and any circumstances that may affect this application. I understand that this is an application only and may not necessarily result in funding approval. I confirm that if this application is approved I will agree to any audit process that Empowering Eaglehawk Inc. may require. I agree to providing Empowering Eaglehawk Inc. with an evaluation of this project by proposed date.