Community Grants Application Form

Full Name

Position within the organisation or group

Phone Number

Email Address

Grant Category

Organisation Name

Street Address

Mailing Address - if different to Street Address

Australian Business Number (ABN)

If your ABN is not stated and your application is successful, will your organisation agree to provide Council with a Statement by Supplier form?

Is your organisation registered for GST?

Does your organisation hold current Public Liability Insurance to cover your application's activities?

Please attach a copy of your Certificate of Currency

What is your organisation's Legal Status?

Is this application being Auspiced?

Auspice Organisation Name

Name of the person from the Auspice organisation who has agreed to the submission of this application

Position of the person within the Auspice organisation

Street Address

Mailing Address - if different to Street Address

Australian Business Number (ABN)

If your ABN is not stated and your application is successful, will your organisation agree to provide Council with a Statement by Supplier form?

Is your organisation registered for GST?

Does your organisation hold current Public Liability Insurance to cover your application's activities?

Please attach a copy of your Certificate of Currency, if applicable

What is your organisation's Legal Status?

Please specify

Account Name

Account Number

BSB Number

Bank Name

Name of event, project, activity or equipment

Expected event, project or activity timeframe (including start and finish dates)

Location where the event, project or activity will occur

Will the event, project or activity be offered to the whole of the Wollondilly Shire?

Requested funding amount? (The requested amount can not exceed the maximum amount allowed for your selected grant category)

Describe the event, project, activity or equipment that the funding is being requested for

Explain why you are holding the event, project, activity or purchasing equipment

How does your event, project, activity or purchase of equipment link to Council's Community Strategic Plan?

Who are the primary target groups for your application?

Please specify

Will you be working in partnership with other organisations?

Please provide details about each organisations roles and responsibilities

Have you sought funding from other sources for your event, project, activity or equipment?

If Yes, please provide details about who the funding is requested from, the amount requested and the amount received/approved

Please provide details of all sources of income for the project including income generated by fees, donations, financial contributions from other organisations etc.

Please provide details of all sources of expenditure for the project including contractor fees, materials, promotional costs, equipment hire, small capital equipment purchases etc.

Please provide details of any in-kind contribution the organisation and partners will be making towards your application such as volunteer labour, use of a facility or equipment etc.

Total amount of funding requested from Wollondilly Shire Council?