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2022 Ballarat Innovation Grant Application Form

Use this application form to apply for the Ballarat Innovation Grant.

The Ballarat Foundation will distributes a single grant of up to $50,000 to community groups with a new or innovative project or program that has been operating for less than 12 months (at 30 June 2022) and supports at least one of the Ballarat Foundation’s four pillars of focus:

o    Food Security
o    Housing Security
o    Early Childhood Success
o    Youth Success

Written applications close at 5:00pm on Friday 24 June 2022

Please note that applicants will be required to make a written application AND, if short-listed, present in person or via video link to the selection panel.

If you require any assistance with this application form please contact the Ballarat Foundation on 5331 5555 or email: info@ballaratoundation.org.au

Which of the four Grant Program Impact Areas will this project meet?

What is the name of the project/program?

Please provide a summary of the project/program (300 words)

Please explain how the project/program will apply a new or innovative approach to reducing disadvantage? (300 words)

Which Local Government Areas (LGAs) will the project/program be delivered in?

What is the time frame for the project (ie currently running, yet to start, start date, end date etc)

How does your project align to the key areas of the grant program? (refer to grant guidelines) (300 words)

How many people do you expect to benefit from the project? (both directly and indirectly)

How many staff will be involved?

How many volunteers will be involved?

What are the expected outcomes of the project/program? (200 words)

How will you know if these outcome have been achieved? (200 words)

What other groups or bodies have you applied to for funding for this project/programs? (select all that apply)

If Other, please provide details

Are you aware of any other organisations, in this region, providing the same project/program?

YesNo

If Yes, please provide details

What is the grant amount you are seeking for this project/program? (inclusive of GST)

Please upload a PROJECT BUDGET for the project/program (a budget template is available to download from the Ballarat Foundation grant website)

Please upload a BUSINESS PLAN that explains:

- How the project will be sustained beyond the initial funding.

- Any revenue streams which will be developed.

- The community partners the program will work with to support outcomes.

- The support that will be required to ensure the project delivers long term impacts for the community.

- Any risks to the success of the project/program.

Upload BUSINESS PLAN (pdf, word preferred)

Is your organisation registered for GST?

YesNo

If you have received funding from the Ballarat Foundation in the past 2 years have you fully acquitted that funding?

YesNo

Note: Applicants that have failed to acquit any grants from previous Ballarat Foundation distributions will be ineligible to apply. This relates to any projects or programs operated by the applicant organisation.

What is the legal name of the organisation or group running this project and to whom the funds will be supplied?

What is the ABN of this organisation?

Does this organisation have: (select all that apply)

Australian Charities and Not-for-Profit Commission (ACNC) registrationDeductible Gift Recipient (DGR) status from the Australian Taxation OfficeEndorsement as a Tax Concession Charity (TCC)

If your organisation does not meet any of these requirements, you must state, with examples, how the project is charitable as defined in the Charities Act (2013).

Does the organisation have bank account(s) in its own name?

YesNo

Please upload a copy of the organisations most recent Annual Report

Alternatively, provide a link to a copy on the organisations website.

Please attach a copy of the organisatitons most recent organisational audited financials.

Who will be the PRIMARY contact for the organisation or group running the project? (Note: this will be the person that the grant agreement will be sent to)

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State

Postal Code

Declarations

I declare that the information in this application and any attachments is true and correct at the time of submission and I am authorised to submit the application on behalf of the organisation. If successful, we will meet the conditions of the funding agreement.I understand that the Ballarat Foundation may on occasion forward and/or discuss my application with external reviewers for the purpose of assessment.

Contact details of the person completing this declaration.

First Name

Last Name

Phone

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