Foundation Barossa Community Grants Application Form 2019

Foundation Barossa Community Grants Application Form 2019
Date

Month Day Year
Date Date Picker Icon
Organisation Name *
ABN *
Contact Name *
Phone Number *

Area Code Phone Number
Email *
example@example.com

Address *

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

Does your organisation work within the Barossa region? *
Does your organisation have Tax Concession Charity (TCC) endorsement? *
Please attach a copy of the TCC endorsement from the ATO

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Does your organisation have Deductible Gift Recipient (DGR) status? *
Please attach a copy of DGR endorsement from the ATO

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Provide a brief overview of your organisation's main purpose and activities (Max 100 words) *

0/100
Name of Project *
Select Area of Application *
Project Outline (Max 200 words) *

0/200
Who will benefit from your project? *
Why is this project needed? *
Are there any similar services provided by another organisation in the region? If answered yes, please provide details *
Are there any other organisations or partners involved in this project? If yes, please outline their involvement *
How will you determine if the project has been successful and what process or method will you use to evaluate the project? *
Grant Amount requested for Project *
$
Please attach a copy of your project budget *

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Excel spreadsheet or word document only Cancel of
Are you currently receiving or have you previously received a grant or funding for this project from Foundation Barossa?

Yes No
Are you currently receiving or have you previously received a grant or funding for this project from anyone other than Foundation Barossa?

Yes No
If you do not receive a grant from Foundation Barossa will this project go ahead?

Yes No
I declare that I am authorised to seek funding on behalf of the organisation and that any information given on this form is complete and correct and that no relevant information has been withheld *

Yes
Please correct any errors before submitting this form
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Foundation Barossa Community Grants Application Form 2019

Please correct any errors before submitting this form