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Greening Fund
APPLICATIONS CLOSE 5PM FRIDAY 28 FEBRUARY 2020
This form must be saved to your computer before completing. Forms completed in a web browser may not save correctly and your application could be lost. Please open and complete this form using Adobe
Reader, which can be downloaded for free here.
2019/2020
July 2018 to June 2021
Organisation name:
Project name:
Amount requested (excluding GST):
INFORMATION FOR APPLICANTS
Please forward completed application form and supporting documents to:
By post:
Administration and Special Projects Officer City of Kwinana PO Box 21 Kwinana WA 6966
In person:
City of Kwinana Corner of Sulphur Road and Gilmore Avenue, Kwinana WA 6167 Hours: 8.30am to 4.30pm
Via email:
Subject: Greening Fund Application Form – COMS 110
1. Applications close 5pm on Friday, 28 February 2020. Please note that late applications will not be accepted.
2. Please read carefully the attached Kwinana Greening Fund Guidelines before completing the application form, ensure that all questions are answered and relevant documents are attached prior to submitting.
3. Please tick off the Checklist on the last page of the application form before sending in the application. Under no circumstances will incomplete applications be accepted.
4. If you have any questions about the guidelines or require information about how to apply, please contact the City of Kwinana on 9439 0200 or email [email protected].
5. Your application should be typed (if possible), however handwritten applications are acceptable provided the writing is clear and legible.
6. If you have trouble understanding these forms in English, please call the Translating and Interpreting Service on 13 14 50.
7. The application form is also available at the City of Kwinana website www.kwinana.wa.gov.au.
Kwinana Greening Fund
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ORGANISATION DETAILS
Legal name of organisation:
Operating name: ABN no:
Is your organisation registered for GST? Yes No Is your organisation incorporated? Yes No Does your organisation have public liability insurance? Yes No
Organisation address:
Contact person 1: Position in organisation:
Contact phone 1: Email:
Fax: Website:
Contact person 2: Contact phone 2:
Has your organisation previously received funding from the Kwinana Greening Fund? Yes No
If ‘yes’: Have all acquittal requirements been met? Yes No
Briefly outline the function of your organisation:
LEGAL AGREEMENT
I hereby certify that I have been authorised to prepare and submit this application on behalf of the above mentioned group/organisation and to the best of my knowledge, the information contained herein is true and correct at the time of writing. On behalf of the abovementioned group/organisation, I agree to accept funding in accordance with the Program’s guidelines and conditions.
Signature Date
Name Position
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PROJECT DETAILS
Title of project: Location of project:
Is this a joint project? Yes No If ‘yes’: with whom:
BRIEF DESCRIPTION OF THE PROJECT
If the full amount is not granted, will your project go ahead regardless? Yes No
INCOME AND EXPENDITURE SUMMARY
Please detail all items of expenditure and sources of income for your project including in-kind contributions. Please ensure all costs are listed excluding GST.
EXPENDITURE ITEM (what are you buying)
$ EXPENDITURE
INCOME SOURCE (where is the money coming from for the project including inkind))
$ INCOME
TOTAL EXPENDITURE (ex GST) $ TOTAL INCOME (ex GST) $ GST $ GST $ TOTAL EXPENDITURE (inc GST) $ TOTAL INCOME (inc GST) $
TOTAL GRANT REQUESTED FROM THE KWINANA GREENING FUND (Max $ ex GST)
$
(please attach further details of Project Description if insufficient space below)
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WRITTEN PROPOSAL
To be completed by all applicants. Please provide a written proposal that explains your project and provides evidence that it is well planned and achievable including:
• what you are going to do;• where and when you intend to do it;• how you plan to do it;• why you want to do it, including the projects aims and objectives:• how it will benefit the community; and• how you intend to evaluate it.
Please ensure your proposal is no more than two pages long.
Is this a new or existing project? New Existing If existing, how long has the project been running?
Your proposal (what do you intend to do?):
GRANT CRITERIA
Please keep answers to fewer than 100 words. You may use dot points.
1. Type of project, please tick one box.
Restoration of bushland areas
Arts and cultural
Heritage/history
Installation of trees in streets or parks 2. What are the objectives of your project?
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3. Are you applying for a single project or multiple?
Single
Multiple
4. How will your project benefit the community of Kwinana?
5. How does your project involve collaboration with other groups?
6. Is your program located on Council managed land? (For assistance, see Intramaps)
Yes
No (if no, has land owner’s permission been sought?)
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FEEDBACK
How did you hear about Kwinana Greening Fund?
Advertisement, newspaper
Word of mouth
City of Kwinana’s website
Other social media
Other (please specify)
CHECKLIST (please tick)
Make sure that your project is clearly described and that you have completed all sections of the application. Check that you have supplied one copy of your completed application and all necessary supporting
documentation including quotes for purchases over $500. Make sure that you have addressed all evaluation criteria. Make sure that you have signed the application. Make arrangements to submit the application before the closing date and time.
FOR ASSISTANCE COMPLETING THIS APPLICATION PLEASE CONTACT:
Environmental ServicesCity of KwinanaEmail: [email protected]: 9439 0200
