COMMUNITY FUNDING STREAMS

APPLICATION FORM
APPLICATION CHECKLIST – Have you:

 Checked eligibility against guidelines?

 Completed all sections of application form?

 Attached relevant supporting documents (quotes, insurances, letters of support)?

 Phoned a Council officer to review your draft application/discuss your project?

 Obtained land owner’s support (written evidence should be attached)?

Which community funding stream are you applying for?

 Small Project Grant (up to $1,500 – assessed monthly and funding available all year).

 Community Grant (up to $5,000 – applications open March-Feb annually, funding available as of
following financial year).

Consulting Council Officer:

Amount of funds requested: $

Will you accept part funding for this project:  Yes / No 

Your organisation:

Your project:

What is the role of your organisation?

Number of members: ABN: Incorporated:  Yes /  No

 Yes, I have attached a copy of the organisation’s Certificate of Currency for Public Liability Insurance.

 Yes, I have written evidence of the landowner’s approval for this project.

Contact Person:

Postal Address:

Phone: E-mail:
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Project Location:

Proposed Dates:

Estimated number of participants/beneficiaries in the West Tamar:

Do you have all the relevant approvals for this project (see Guidelines p. 4)? Please provide details:

Has your organisation received funding from Council over the past 5 years? Please provide details:

CRITERIA 1: What is your project and how will you achieve/deliver it? (5-10 dot points).

CRITERIA 2: How does your project meet Council’s Funding Priorities? (1-3 dot points).

Funding Priority: _____________________________________________

CRITERIA 3: Why are you undertaking this project (what are your aims)? (3-5 dot points).

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CRITERIA 4: You must answer Part A, you may tick Not Applicable for Part B.

Part A: Who will your project benefit and how do you engage with them? (5-10 dot points).

Part B: How will the wider community benefit from this project? (This may include
research/statistics, letters of support).

 Not Applicable

CRITERIA 5: How will you show that your project aims have been achieved (how will you evaluate your project)?
(3-5 dot points).

CRITERIA 6: BUDGET

Part A: Based on the Community Funding Guidelines, which items of expenditure will Council
funding be used for?

Part B: Please complete the table over the page.

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Reminder: Applicants seeking more than $1,000 must contribute at least 10% of the overall financial cost of the
project, or have this funding confirmed from an external source.

In-kind labour is not an eligible income source and only donations of labour from qualified
professionals may be included in the Income Description (when supported in writing by the
contractor/provider).

Project Expenditure: Include all costs associated with the project and attach quotes.
Expenditure Description: $

Expenditure Total:

Project Income: Include all confirmed funding and donations, including materials.
Income Description: $
Requested Council Funds:
Organisation Contribution:
Other:

Income Total:

 All relevant quotes are attached.

Any more information you wish to provide?

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DECLARATION

By signing and submitting this form I declare that the information given in this application is true and accurate to the
best of my knowledge. I agree to liaise with Council, should my application be successful, if there are any changes to
the project and to submit and acquittal form within eight (8) weeks of the project’s completion.

PRIVACY STATEMENT

The information that Council is collecting from you is personal information for the purposes of the Personal
Information Protection Act 2004 (the Act). The intended recipients of the personal information are:

 Council officers,
 Data service providers engaged by Council from time to time, or
 Any other agent.

The supply of information by you is voluntary. If you cannot provide or do not wish to provide the information sought,
West Tamar Council may be unable to process your application. Council is collecting this personal information from
you in order to process this application for Community Funding. You may make application for access or amendment
to information held by Council. Enquiries concerning this matter may be addressed to the Personal Information
Protection Officer.

Name:

Organisation:

Position:

Signature:

Date:

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