P500 Grant Application

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Part A

Details of applicant organisation

Organisation name:

Address

Street:

Suburb:

State:

Post code:

Website:

Facebook page:

ABN:

Contact person

First name:

Last name:

Position held:

Phone number:

Email:

About your organisation

Please give a brief description of your organisation and details of its services (maximum 250 words):

Is your organisation...

Endorsed DGR 1?Your organisation must be endorsed as a DGR 1 to be eligible to apply for the P500 Grant.

Part of a wider body that operates outside of Geelong?

Does your organisation have public liability insurance?

Please include a copy of your accounts for the last financial year (even if not audited).

Part B

The project

Project title:

Only one $68,000 grant is available for the P500 grant round. Please read the information about the program on our website to ensure you understand the application process.

Please give a brief description of the community wellbeing project (maximum 200 words). An opportunity for a more detailed description of the project is available below.

If volunteers will help implement the program, indicate the estimated time involved and any special skills or training required (maximum 300 words).

If this project is a new initiative, do you propose to keep it operating after the completion of the P500 Grant, and if so how? (maximum 300 words).

Part C

Project details

Please state your project's key objectives and the specific community needs/issues it will address (maximum 500 words).

Who will your project benefit? Will it benefit any specific group defined by religion, ethnicity, gender, etc? (maximum 250 words).

Project Plan completed.Please complete the Project Plan in the Excel spreadsheet provided. You will have an opportunity to upload this Excel document later in this form. Please note there are 3 worksheets to complete - Budget, Narrative and Project Plan.

Where will the project take place? (What LGA?)

What changes/outcomes are you seeking to achieve in the short and long term and how will you measure them? (maximum 500 words).

What will be the impact of your project on the community and your client/organisation? (maximum 500 words).

Is this application part of a larger project?

Please give details of the larger project (maximum 250 words).

Has your organisation explored opportunities to partner with other community organisations to deliver this program/project?

Please give details of partnerships explored (maximum 250 words).

Has alternative funding been applied for?

Please give details of applications for alternative funding (maximum 250 words).

Part D

Project budget

Please upload our Excel template showing your project budget.

(Only .xls, .xlsx & .csv files will be accepted).

Does your organisation have reserves, and if so, is there any reason why they cannot be used in supporting this project? (maximum 250 words).

Recognition of grant

Detail how you will acknowledge the Geelong Community Foundation's contribution to your project, e.g. organisation's newsletter, annual report, website, social media, newspaper article, radio interview, etc. (maximum 250 words).

Reporting and grant acquittal

The Geelong Community Foundation will require a Grant Acquittal including photographs as appropriate on completion of the project. An audited report covering budget and actual costs may be requested for certain projects. It should be noted that in some cases, a Foundation Board or staff member may request an on-site review of the funded program.

Page E

Certification and privacy

The Geelong Community Foundation is committed to protecting your privacy and ensuring that all information provided in relation to this grant application is kept confidential. During the assessment process however, the Foundation may need to collect, use and disclose information about your organisation and the project to third parties. This information could be passed on to the Board of the Foundation, its officers and agents or external people to assist in assessing the grant application.

Permission to forward this application to other funding organisations for consideration.

Permission to forward this application to individuals and experts for assessment.

Check this box if you wish to opt out of the Geelong Community Foundation's email mailing list.

Declaration

I confirm that the CEO/Manager/Chairperson has certified that the information in this application is true and correct.

Name and role of CEO/Manager/Chair:

I am authorised by my organisation named in this application to make this application on its behalf. I confirm that my organisation agrees to the terms and conditions relating to grants of the Geelong Community Foundation detailed in the Grant Agreement.

The applicant acknowledges that the Foundation is under no obligation to make a grant even though the applicant meets all the guidelines and eligibility requirements.

Enter your name below to agree to these conditions:

Attach one other relevant file here (if required). Maximum 5MB.

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