Community Assistance Grants and Sponsorship Program Funding Application Form

Applicant details

Organisation name*

Postal address*

Is the organisation located within the Town of East Fremantle?*

YesNo

Contact name*

Position*

Phone number*

Email address*

Please provide the following financial details of your organisation

ABN*

No ABN Statement attached

No ABN? Please complete and upload a Statement by Supplier from the ATO

https://www.ato.gov.au/

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Is your organisation GST Registered?*

YesNo

Is your organisation incorporated? Please attach a copy of your Certificate of Incorporation*

YesNo

Is your organisation a Not-For-Profit?*

YesNo

Project Summary

Project name*

Total project value*

Funding amount requested*

Description (briefly describe your project or event up to 25 words*

Project Details

Describe your project or event*

Expected start date*

Excepted completion date*

Does your project focus on a particular target group?*

YesNo

What target group does your project focus on?*

Children (up to 12 years)Young people (12 to 25 years)Over 55s
People with disabilitiesOther (please specify)

If your project targets people in the 'other' category, please specify

Are you working with any other community groups or businesses in the delivery of this project? If yes, please provide details

Why should this project be a priority for the Town of East Fremantle?*

Additional funding information

The Town of East Fremantle encourages community groups to apply for funding from alternative sources either prior to or simultaneously to their application for Town funding.

Have you sought funding from any other organisations?*

YesNo

Please tell us the organisation, status and outcome of your external funding sources

If no, what are the reasons your organisation has not sought alternative funding?

Project Budget

Please provide a detailed budget for the project or event for which you are requesting funds. All costs should be itemised in the space below. Quotes are required for costs over $500. Please note that your income and expenditure should match.

Include cash expenditure item, supplier and cash cost in separate columns and total cost.

Tell us about your cash contribution, the funder and cash income amount*

Please upload quotes for over $500

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Tell us about the in-kind item or activity volunteers play, by whom and in-kind value in dollars*

What is the project/event value *total cash cost + total in-kind value*