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Disability Awareness Week 2017Thank you for your interest in the Disability Awareness Week grants. Before completing and submitting this form please ensure you have read and understood the information in the Grant Guidelines available at www.disability.wa.gov.au > About us > Disability Awareness Week.
Enquiries: Phone 9426 9622 or email [email protected]
Grant application form
Applicant details
Organisation and contact details
Organisation name:
Contact person and position title:
Phone:
Email:
Postal address:
Auspicing organisation (if applicable)If your organisation or community group is not incorporated, the grant must be applied for on your behalf by a not-for-profit incorporated organisation or a local government. The auspicing organisation will be responsible for accepting and adhering to the conditions of the grant, maintaining financial records and providing acquittal information, should your application be successful. The auspicing organisation’s legally authorised officer must sign the Authorisation section at this end of this form.
Organisation name:
Contact person and position title:
Phone:
Email:
Postal address:
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Event details
Event name:
Date/s and time/s:
Venue and location:
Briefly describe your event
How will this event celebrate people with disabilities and raise awareness of the importance of welcoming, accessible and inclusive communities? (please address the eligibility criteria)
How will you use the grant money?
Item Cost (approximate)
TOTAL COST
Grant terms and conditions
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On behalf of the organisation, please tick ‘yes’ to agree or ‘no’ to disagree to the terms and conditions outlined below.
Yes No
The event venue is accessible to people of all abilities. ☐ ☐We give permission for the event information to be published on Communities digital channels, including its websites, social media platforms and e-newsletters, and via Disability Services and ministerial media releases.
☐ ☐
We will supply high-resolution photos of the event with signed consent forms of participants for use in a range of Communities digital and print publications. ☐ ☐Our organisation/group has appropriate insurances (public liability etc.). ☐ ☐If required we will provide Communities the information or evidence needed to prove how the grant criteria and terms and conditions were met. ☐ ☐We will return the grant money in full to Communities if the event does not take place. ☐ ☐
Authorisation
To be completed by the Chief Executive Officer or authorised delegate:
Signature:Print full name and position:
Date:
Submitting your application
Disability Awareness Week grant applications close at 5.00pm on Wednesday 1 November 2017 and can be submitted the following ways.
Email to: [email protected]
or
Post to: Disability Awareness Week GrantsSector Engagement & Development BranchDepartment of Communities, Disability ServicesPO Box 441West Perth WA 6872
Please note: applications postmarked prior to, or on the closing date, but received after that date, will not be accepted. We encourage you to email your application to ensure it arrives by the closing time and date.
