2017 Community Grant

Community Grant Application Form

Application Deadline - April 30, 2017
Read and follow the instructions carefully prior to submitting your application.

Please read the eligibility criteria for the scholarship you are applying for prior to sumitting your application.

All terms and conditions regarding community grants can be found on the Foundation Barossa website.

All applicants will be notified on or before the 30th May, 2017.
If selected, you will be asked for documentation to support the data you provide, each grant may require different information or have different requirements for selection. Likewise, all correspondence and agreements will be generated from the information submitted below. So, please use proper spelling, capitalisation and punctuation.
I have read and understood the instructions. *

Yes, I have
I. ORGANISATION DATA:

Tell us about your organisation. Please note: individuals are not eligible to apply for Foundation Barossa Community Grants.
Organisation name: *
ABN:
Contact person: *

First Name Last Name
Contact No. : *

- Area Code Phone Number
E-mail : *
Where the confirmation will be send to

Postal Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your organisation work within the Barossa region? *

Yes No
Please outline the aims and objectives of your organisation.
Does your organisation have Tax Concession Charity (TCC) endorsement? *

Yes No
Please attach a copy of the TCC endorsement from the ATO
Does your organisation have Deductible Gift Recipient (DGR) status? *

Yes No
Please attach a copy of the DGR endorsement from the ATO
II. PROJECT INFORMATION
Name of project: *
Area of application: *

HEALTH & COMMUNITY WELL BEING ENVIRONMENT COMMUNITY DEVELOPMENT DISADVANTAGED ARTS & CULTURE THE AGED EDUCATION & TRAINING YOUTH
DESCRIBE YOUR PROJECT

The following questions will assist you to briefly describe the project or activities proposed. Please answer all questions to the best of your ability. Further information including letters of support or project plans can be attached as pdf or word documents.
BRIEFLY DESCRIBE YOUR PROJECT

You should address: why you have developed this particular project and why this project is important to your organisations strategic plan. You may also include any of your organisations history including accomplishments and achievements that make your project uniquely worthy of support.
Project outline (300-500 words). *

0/500
Project start date

- Day - Month Year
Project end date

- Day - Month Year
Who will benefit from your project? *
Why is there a need for your project? *
Are there any similar services provided by any other organisations in the region?

Yes No
Are there any there any other organisations or partners involved in your project? *

Yes No
If you answered yes to the previous question, please outline the involvement of any partners or other organisations.
How will you determine if the project has been successful and what process or method will you use to evaluate the project? *
ADDITIONAL PROJECT INFORMATION.

Further information regarding your project, inlcuding project plans, council development or approval documents and letters of support can be added below.

These documents must be pdf or word documents and cannot exceed 2MB in size.
Project plan or approval documentation

Upload a File
A maximum of two project documents can be included. Cancel of
Letters of support

Upload a File
A maximum of two letters of support can be included. Cancel of
III. FINANCIAL INFORMATION
Grant amount requested for this project: *
Use whole dollar amounts. Do not include $.
Are you currently receiving or have you previously been awarded an grant by Foundation Barossa? *

Yes No
Are you currently receiving or have you previously been awarded a grant for this project? *

Yes No
If this project has received other funding, please outline details of the funding received or applied for to date.
If you do not receive a grant from Foundation Barossa will this project go ahead?

Yes No
Please attach a copy of your project budget (excel spreadsheet or word document only) or add your budget items in the table below.

You must include:

Item: the name of each item funded

Cost: the cost of each item

Funded by: which organisation will fund the item (i.e. Foundation Barossa, your organisation or another funder)
Upload your budget file (word or excel files only)
IV. Applicant's E-Signature
I declare that I am authorised to seek funding on behalf of the Organisation and that the information given on this form is complete and correct and no relevant information has been withheld. *

Yes No
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Community Grant Application Form

I. ORGANISATION DATA:

II. PROJECT INFORMATION

III. FINANCIAL INFORMATION

IV. Applicant's E-Signature