Sport in the North Grant Application Form

Please choose what the required funding is for

Applicant Organisation

Address

Street Address Address Line 2 City State Postcode

Postal Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Person Name

Position Held

Mobile/Contact number

Website

Is your organisation a Registered Not-For-Profit?

Yes

Your Organisation ABN

Your Organisational DGR Status (if applicable)

Is your organisation or group incorporated?

Yes

Is your organisation or group registered for GST?

Yes

Are you being auspiced by an intermediate organisation for this application?

Yes

If Yes, please provide their name, address and ABN details

Is the auspice organisation or group registered for GST?

Yes

In not less than 100 words describe your organisation, including your organisation’s principal activities, membership base and the location where your principal activities are undertaken.

Complete where applicable

Title of Project / Program / Event / Sponsorship

Describe your project

In no less than 100 words, describe what a grant from GCC will be used for.

Articulate the community outcomes that you believe your project will achieve

Please describe in no less than 100 words

Grant Amount Requested $

Does this amount cover the full project cost?

Is there funding available from other organisations to support your project?

Do you intend to apply for funding elsewhere?

When will your project / program / event happen?

When will funding be required?

How will your organisation or group promote your grant from Geelong Connected Communities in the community?

Please describe here

Social Media

Signage

Newsletter

Radio

At events - verbally, clothing, website or other

Have you received grant funding from GCC in the last 12 months?

Supporting Documentation Upload

For grant applications over $500, please upload a written project budget. (Sponsorship applications up to $500 do not require a budget).

Max. file size: 128 MB.

Insurance (For event sponsorship only)

Prior to funding, event applications require: - Certificate of Currency for Public Liability Insurance

Max. file size: 128 MB.

Permits and approvals (For event sponsorship only)

Prior to funding, event applications require: - Copies of approvals and permits from the property owner of the event location

Max. file size: 128 MB.

Has your organisation completed the acquittal documentation for any previous Geelong Connected Communitiees grants?

Please detail any previous Geelong Connected Communities Grants

Note, applications from previous grant recipients will only be considered if an acquittal for previous funding has been submitted.

By typing in your name below you acknowledge that: • I am authorised by my Applicant Organisation named in this application to make this application on its behalf. I confirm that the Applicant Organisation agrees to the terms and conditions relating to the grants of Geelong Connected Communities. I confirm that all information provided in or with this application is true and complete. • The Applicant Organisation acknowledges that Geelong Connected Communities is under no obligation to make a grant even though the Applicant Organisation meets all guidelines and eligibility criteria requirements. Signed for and on behalf of the Applicant Organisation.

Name/Title

Name

This field is for validation purposes and should be left unchanged.

Complete where applicable

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