example only - amazon web services€¦ · love my place grants application form form preview...

Love My Place Grants Application FormForm Preview

IntroductionBefore Completing this application

1.Ensure you read the Love My Place Grants 2019-20 Information Kit. 2. If youhave any questions discuss your project with your Placemaking Facilitator on 9209 [email protected]

Completing the application

• Save regularly to avoid losing your work! You can also save and return to yourapplication at any time prior to the submission date.

• Navigate the form by clicking Next Page or Previous Page or using the index list.• Having trouble answering a question? Look below each question for hints to help youanswer the question.

• A confirmation email will be sent to you once you submit your application, including aPDF copy of the application for your records.

• You can also return to https://portphillip.smartygrants.com.au at any time to viewa copy of your application.

• After submission, no changes can be made without the assistance of the CommunityGrants and Funding Officer.

Documentation required to be uploaded in this form:

• Public Liability Insurance Certificate of Currency• A recent profit/loss statement of your organisation.• If you are apply through an auspice organisation you will need a letter ofconfirmation from the Auspice

Eligibility* indicates a required field

Before completing this application Love My Place Grants Information Kit 2019-20 if yourequire clarity please contact us on 9209 6433 or [email protected]

Have you read and understood the Love My Place Grants Information Kit? *◯ Yes ◯ No

Are you an incorporated legal entity or auspiced by an incorporated entity? *◯ Yes ◯ No

of 13

EXAMPLE ONLY


Is your organisation a not-for-profit? *◯ Yes ◯ No

Does your organisation operate within the Port Phillip municipality or are youable to demonstrate that the program benefits residents in the municipality? *◯ Yes ◯ No

Are you able to demonstrate financial viability? *◯ Yes ◯ NoYou will need to provide a copy of your most recent annual report or annual statement/ financialstatement submitted to Consumer Affairs

Do you have appropriate insurance for this project? *◯ Yes ◯ NoIncluding but not limited to, public liability, personal volunteer accident insurance, professionalindemnity etc.

If you have answered NO to any of the above eligibility questions you should not proceedwith this application. If you have any questions please contact a Placemaking Facilitator on03 9209 6433 or [email protected]

Lead Organisation Details* indicates a required field

Applicant Organisation * Organisation Name

Primary Address * Address

Address Line 1, Suburb/Town, State/Province, Postcode, andCountry are required.

Postal Address * Address

Address Line 1, Suburb/Town, State/Province, Postcode, andCountry are required.

Primary Website

Must be a URL.

Provide a briefdescription of yourorganisation? *

Word count:What is its core business? 100 words or less

of 13

EXAMPLE ONLY


Name of contact person*

First Name Last Name

Position held withinorganisation *

Contact Telephone * Email Address * Are you applying as * ◯ An Incorporated

Organisation◯ An Organisation or Groupwith an Auspice

Are you partnering withany other organisationsor businesses to deliverthis project/program? *

◯ Yes ◯ No

Incorporated Organisations or Business

What is yourorganisation's AustralianCorporation Number(ACN) *

Must be an ACN https://abr.business.gov.au/

ABN * The ABN provided will be used to look up the followinginformation. Click Lookup above to check that you haveentered the ABN correctly. Information from the Australian Business Register

ABN

Entity name

ABN status

Entity type

Goods & Services Tax (GST)

DGR Endorsed

ATO Charity Type More information

ACNC Registration

Tax Concessions

Main business location

Must be an ABN.

Auspice Organisation Details

of 13

EXAMPLE ONLY

http://abr.business.gov.au/HelpTaxConcessions.aspx


* indicates a required field

Auspice Organisation Details

Auspice Organisation * Organisation Name

Auspice Postal Address * Address Address Line 1, Suburb/Town, State/Province, Postcode, andCountry are required.

Has the AuspiceOrganisation agreed tomanage the grant? *

◯ Yes ◯ No

Please attach a signedcertification letter bythe Officer Bearer of theAuspice Organisation *

Attach a file:

Auspice Contact Person*

Title First Name Last Name

Auspice Contact PersonPosition *

Auspice Contact PersonOffice Phone Number *

Must be an Australian phone number.

Auspice Contact PersonOffice Email *

Must be an email address.

What is the auspice'sAustralian CorporationNumber (ACN) *

Must be an ACN https://abr.business.gov.au/

Auspice ABN * The ABN provided will be used to look up the followinginformation. Click Lookup above to check that you haveentered the ABN correctly. Information from the Australian Business Register

ABN

Entity name

ABN status

of 13

EXAMPLE ONLY


Entity type

Goods & Services Tax (GST)

DGR Endorsed

ATO Charity Type More information

ACNC Registration

Tax Concessions

Main business location

Must be an ABN.

Project Criteria* indicates a required field

Project Benefits and Community Inclusion

How will your project contribute to one or more of the social, cultural, economic,physical and environmental capital of either Fitzroy Street or South Melbourneplacemaking precinct?

Word count:Must be no more than 100 words.What is the justification for doing this project? How does it contribute to these areas?

How will your project promote inclusion and diversity and strengthen yourcommunity?

Word count:How will your project attract, include and celebrate all different types of people? (max. 100 words)

Co-Contributions

Outline the co-contribution to be provided for your project. This co-contributioncould be financial or non-financial.

Word count:Must be no more than 100 words.What funding or resources will you be providing to deliver this project?

Temporary in Nature

Can your project be quickly implemented and altered in response to communityfeedback, if required?

of 13

EXAMPLE ONLY

http://abr.business.gov.au/HelpTaxConcessions.aspx


Word count:Explain how, if needed, your activation could be promptly removed or altered. (Max. 100 words)

Collaboration

Outline who is involved in your project and support you have from any neighboursor those who may be affected. A collection of local businesses in collaboration canapply for a Project.

Word count:Must be no more than 200 words.Outline who is involved and how you will work together

Name of partnership organisations and businesses? How will the organisations work together to achieve the project goals *

Word count:Must be no more than 100 words.What are your group's roles and responsibilitites, the terms of the partnership?

Project Details* indicates a required field

Project Title * Brief description of theproject *

Word count:Please provide a brief PUBLIC PROJECT DESCRIPTION that ifsuccessful we can use it to promote your project on our website.Please include: who, what, where and when in no more than 30words.

Project Start Date * Must be a date and no earlier than 8/11/2019.Projects must delivered between 8 November 2019 and 30 June2020

Project End Date *

of 13

EXAMPLE ONLY


Must be a date and no later than 30/6/2020.Projects must delivered between 8 November 2019 and 30 June2020

Which City of Port PhillipPlacemaking Precinctwill your project bedelivered in?

☐ South MelbournePlacemakingPrecinct

☐ Fitzroy StreetPlacemakingPrecinct

Projects cannot be delivered outside the defined placemakingprecincts. See Love My Place Grant Guidelines for definedprecinct locations

Project Proposal* indicates a required field

Please provide the core details of your project (for example, what, when, who, why, whereand how). From reading this answer, someone should be able to understand the corepurpose and activities you plan to deliver.

Please provide an overview of your proposed project: *

Word count:Must be no more than 200 words.Please include location if valid.

What are the expected outcomes of the project? *

Word count:Must be no more than 100 words.Describe three things you want the project to achieve in terms of benefits for participants and/orothers ?

Demonstrated need for the project

Why is this projectneeded? How did youidentify this need? *

Word count:How did you identify the need for this project? Have youconsulted with the community? Does your project link to thecommunity's Placemaking Program priorities? Do you have anyresearch/evidence to support your claims? Must be no more than100 words.

Participation

How many people willparticipate in thisproject? *

Must be a number.

of 13

EXAMPLE ONLY


Does your projectinvolve volunteers? *

◯ Yes ◯ No

* This space must be completed for your application to beprocessed.

Marketing & Promotion

What strategies will you use to engage participants? *

Word count:Must be no more than 100 words.

Environmental Sustainability

Does your project improve our environment by measurably reducing waste,energy use and or water? *

Word count:Must be no more than 100 words.Projects that show

Planning and Management* indicates a required field

Project Planning

How will the project/program be planned,managed andimplemented? *


Milestones

In this section we ask that you outline the top 3 Milestones of the project/program.

Milestone 1 Name *

Example Planning; MajorActivities; Evaluation

Milestone 2 Name *

Milestone 1 Description *

Brief overview no more than 50words.


Milestone 1 Expected Completion Date *

Must be a date and between8/11/2019 and 30/6/2020.


of 13

EXAMPLE ONLY



Milestone 3 Name *








Evaluation

How will you knowwhether you haveachieved the project aimand outcomes? *


Project Budget* indicates a required field

Grant Request

There are many resources that can help you with writing a budget including Our CommunityWebsite

Total funds sought fromPort Phillip CommunityGrants: *

$Must be a dollar amount and no more than 10000.

Overall cost of thisproject: *

$Must be a dollar amount

What is the minimumamount of fundingrequired for yourprojects viability? *

$Must be a dollar amount.

In kind contributions:What is yourorganisation'scontribution to thisproject? *

Word count:Must be no more than 100 words.i.e. Volunteer time, supervision, phones, venue, printing etc.

If your organisation isoffered a grant less thatthe amount you haverequested would yoube able to proceed withyour project? *

◯ Yes ◯ No

of 13

EXAMPLE ONLY


If yes, please discussany areas whereprogram costs orprogram outcomes mayvary. *

Word count:Must be no more than 100 words.If No please advise not applicable.

Other Project Income

Please list any other income, apart from this grant that would contribute to the project:

Income $ $ $ $

Expenditure Grant Funding

Please list the items and amounts for how you intend to spend this grant funding only.Other project expenditure is to be provided in the next section

• If successful this table will be included in your grant agreement.• Please provide a clear breakdown of items for example

✖️ Travel $8,400

✔️ 6 economy return airfares $6,000

✔️ 2 nights accommodation for 6 $2,400

Expenditure $ $ $ $

Expenditure Other Project Costs

Please outline other project costs that will be incurred but you will not spend the grantfunding on

Expenditure $ $ $ $

Budget Totals

The below totals are calculated from figures you have entered above. The balancecalculation is to check that your budget balances EG:Income - Expenditure = Balance

• The balance must equal 0 or you will not be able to submit. If your balances are not 0please check your figures.

of 13

EXAMPLE ONLY


Income Expenditure BalanceTotal Grant Income

$This number/amount iscalculated.

Total Expenditure Amount


Grant Balance


Additional Information* indicates a required field

Please enclose the following information relating to your organisation:

Copy of most recentannual report or annualstatement/ financialstatement submitted toConsumer Affairs *

Attach a file:

Public liability insurancecertificate *

Attach a file:

Copies of relevantinsurance such aspersonal volunteerinsurance, professionalindemnity etc.

Attach a file:

Letter of support from arelevant organisation

Attach a file:

Other documentationsupporting theapplication.

Attach a file:

Application Checklist* indicates a required field

1. Have you enclosed the following documents?

Most recent annualreport or financialstatement/annualstatement submitted toConsumer Affairs. *

◯ Yes ◯ No

of 13

EXAMPLE ONLY


Brochures and orpromotional material.

◯ Yes ◯ No

Letter of support fromrelevant organisation

◯ Yes ◯ No

2. Have you answeredall the questions on theapplication form? *

◯ Yes ◯ No

3. Has an authorisedperson from theapplicant organisationapproved the applicationform? *

◯ Yes ◯ No

4. Have you includedeither your organisationor the auspiceorganisation's ABN? *

◯ Yes ◯ No

* This space must be completed for your application to beprocessed.

Declaration* indicates a required field

I certify that all details supplied in this application form and in the attached documents aretrue and correct to the best of my knowledge and that the application has been submittedwith the full knowledge and agreement of the management/committee of the applicantorganisation.I have read the Love My Place Grants Information Kit and understand the informationcontained within it forms part of the conditions of payment if this application is successful.I agree to contact the City of Port Phillip in the event that any information regarding thisapplication changes or is found to be incorrect.

* ◯ I agree to the above

Declarant * Title First Name Last Name

Organisation Name * Organisation Name

of 13

EXAMPLE ONLY


The personal information requested on this form is beingcollected by the council for the Love My Place GrantsProgram as a part of the City of Port Phillip PlacemakingProgram. The personal information will be used solely bythe council for that primary purpose or directly relatedpurposes. If this information is not collected the Grantapplication will not be considered eligible, and thereforewill not be considered during the assessment process.The applicant understands that the personal informationprovided is for the verification of Love My Place Grantsapplication and correspondence purposes and that heor she may apply to the council for access to and/oramendment of the information. Requests for access and orcorrection should be made to Council's Information PrivacyOfficer.

Applicant Feedback* indicates a required field

How did you hear aboutthe Love My PlaceGrants Program? *

☐ Local Paper ☐ Word of Mouth☐ Broadcast ☐ Email / Newsletter from

City of Port Phillip☐ E Bulletin ☐ Other: ☐ Council Website

How can City of PortPhillip Love My PlaceGrants program beimproved?


Any other comments? Word count:Must be no more than 50 words.

of 13

EXAMPLE ONLY

example only - amazon web services€¦ · love my place grants application form form preview...

Documents