Grant Application GRANT FUND APPLICATION FORM Grant opening date: 1st June (each year) Grant closing date: 31st July (each year) Contact for inquiries: Wayne Greenham Email: admin@sdcf.org.au SECTION A: ORGANISATIONAL DETAILS Contact Details Applicant / Organisation Name (required) Email Address (required) Postal Address Street Address City State Postcode ABN Contact Person Name Position Mobile Phone Work Phone Organisational Information Provide a percentage breakdown of annual income between: Type Total Government % Philanthropic % Corporate % Fundraising % Service Fees % Other % Please indicate the region in which your service delivery is primarily focussed: NambourNambour and surrounds (within 20kms)Other If Other: Please indicate which area your organisation meets the eligibility criteria: A not-for-profit community organisationA registered charity with the Australian Tax Office (ATO)Endorsed by the ATO as a deductable Gift RecipientAn educational institution Financial DetailsThis information must be from your most recent audited/reviewed financial statements Item Amount ($) Annual Income (Governement) $ Annual Income (Other) $ Annual Income (Total) $ Liabilities $ Annual Expenditure (Total) $ Surplus / Deficit $ SECTION B: PROJECT DETAILS Project Title: Total Budget for Project: $ Attach a detailed budget for the proposed project. E.g. proposed cost for each strategy / component of the project Amount ($) being requested (GST Exclusive): $ Project Start Date: Project End Date: State the principal aim of the proposed project: Describe how the proposed project will meet the eligibility criteria e.g.: A not-for-profit community organisation A registered charity with the Australian Tax Office (ATO) Endorsed by the ATO as Deductable Gift Recipient An educational institution Describe what outcomes are expected to be achieved: Describe how the proposed project will be undertaken, including (or attaching) a detailed project plan, clear description of initiatives and expected timeline for completion of the project and include details of any external service providers: Is there a potential for this project to be shared with other similar organisations/service providers and if so, how and with whom?: If only part funding is required for the proposed project outline how the applicant will fund the whole proposed project: If your application is successful the Foundation requests your agreement to acknowledge the funding from the Foundation in publications, social media, website, etc.: Yes I agreeNo I do not agree If your application is successful the Foundation requests your agreement to be involved in publicity regarding the Foundation's grant program. This may include provision of photographic material for use on social media, displaying promotional materials and participating in the Foundation's fundraising activities: The Applicant acknowledges and agrees that if its Application is successful then to receive its grant it must: (1) Complete, sign and deliver to the Foundation prior to the Foundation’s Award Ceremony a Grant Deed in the form as set out on the Foundation’s website; and (2) Have a representative attend the Foundation’s Awards Ceremony; Failing either of which its grant may be forfeited in the absolute discretion of the Foundation in which event the Applicant will have no recourse against the Foundation or right of appeal. Yes I agreeNo I do not agree Authorised Person Name: Position in Organisation: Authorised Person Acceptance (in lieu of signature): I accept that all information provided is true and correct, and that this application is made in accordance to the Foundation's terms and conditions and privacy policy . Authorised Date: How did you hear about the Sundale Community Foundations Grants? Word of MouthWebpageSocial MediaNewspaper / News MediaOther * Required