Community Grant Application Form

URL

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APPLICANT DETAILS

Prior to completing this application form, please ensure that:

You have read the Grant Guidelines and

You have contacted the Community Foundation to discuss your application

You can save the form and continue at any time by clicking the "Save & Continue" button at the very bottom of the form.

Organisation ABN(Required)

Organisation Name(Required)

Organisation Email(Required)

Postal Address(Required)

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

Website

Contact Person 1

Name(Required)

Phone(Required)

Contact Person 2

Name(Required)

Phone(Required)

Is your organisation incorporated?(Required)

(Please provide Certificate of Incorporation. If not incorporated, you must be auspiced and the auspicing organisation completes this Application)

Yes

N/A

Upload your Certificate of Incorporation here(Required)

Max. file size: 128 MB.

Is your organisation registered with the Australian Charities and Not for Profits Commission (ACNC)?(Required)

See www.acnc.gov.au (this is not a pre-requisite)

Yes

N/A

Is your organisation endorsed for Tax Concession Charity (TCC) or Income Tax Exempt Charity (ITEC)?(Required)

(this is not a pre-requisite)

Yes

N/A

Are you the auspicing organisation for this project?(Required)

(if yes, please provide Memorandum of Understanding between your organisations as well as details of the auspiced Group)

Yes

N/A

Memorandum of Understanding

Max. file size: 128 MB.

Please identify which category your project falls within. You can select more than one:(Required)

Health and well-being

Education

Youth

Aged

Disability

Environment

Arts and Culture

Community Strengthening

Other

PROJECT DETAILS

Tell us about your project

Please complete all of the sections below

Each of the questions 1-7 and 10 should not exceed 250 words

1) PROJECT NAME (Note this name will be used by MNDCF in all public communications)(Required)

2) WHAT are you going to do? WHAT is the purpose of your Project?(Required)

The project description should summarise the main activity of the project, together with a brief description of other activities to be undertaken and most importantly who will benefit from this project and the anticipated outcomes. What you hope to achieve.

3) WHY is this project important? WHY is it needed?(Required)

Please explain how you have identified the need for this project and how is it different from other existing projects. Explain the beneficial impacts the project will have for the community, e.g not just provide an asset but what that asset will enable/achieve.

4) WHO will be involved in the project?(Required)

Include details of any community partnerships or stakeholder support and key staff that might be involved in the project. If the applicant is an auspicing organisation, please detail how the auspice and the organisation undertaking the project will work together. Where project requires planning permits or permission from land/facility owner, please provide documented approval or details of process and expected approval date.

5) WHEN?(Required)

What is the time frame for project? (Note projects should be able to be completed and acquitted by November the following year, unless prior arrangement with the Executive Officer)

6) EVALUATION - How will you know the Project has made a difference in your community? How will you measure success?(Required)

Your evaluation process will depend on the type of project you undertake, but may include:  What will occur if the project is successful that doesn’t occur now? How will you measure that you attained the outcome that your group is seeking? Please provide measurable numbers e.g. train 25 people, reach 60 families. How will you communicate the success and learning of this project and who will you sharing it with? How will the impact of the project be sustainable?

7) BUDGET(Required)

Please provide details of the income and expenditure for your project, excluding GST. The INCOME must equal EXPENDITURE in the totals at the bottom.
Quotes for expenditure must be attached.
Please provide financial statements for your last financial year.

Income (excl GST)

Expenditure

Amount requested from MNDCF (max $10,000)

Equipment and materials

State or federal Govt funding

Labour

Local Govt funding

Administration

Funds from other organisations

Funds from other organisations (specify who)

Operational

Funds from your organisation

Education and Training

Volunteer value to project (hours x value)

In Kind value to project (materials and services)

Other Sources

Other Expenses

Income Total

ExpenditureTotal

Budget - Please provide your Quotes for expenditure.(Required)

Upload your quotes here.

Drop files here or

Max. file size: 128 MB.

Budget - Please provide financial statements for your last financial year.(Required)

Upload your financial statements here.

Drop files here or

Max. file size: 128 MB.

8. Letter/s of support for your project (if applicable)

Please ensure that letters of support indicate how the author will utilise, contribute to, benefit from or otherwise participate in your project. Please limit to a maximum of 3 letters.

Drop files here or

Max. file size: 128 MB.

Any other Supporting Documentation

Drop files here or

Max. file size: 128 MB.

9) If MNDCF is not able to fund your grant application in full, will the project be able to go ahead? (IE. Can the project be delivered in multiple stages or can your organisation fund the shortfall?) Please provide details.(Required)

10) Any other information which is relevant to your application.

If you are applying for an time critical or urgent project, please outline why the project is time critical or urgent.

CERTIFICATION & PRIVACY

The Mirboo North & District Community Foundation is committed to protecting your privacy and ensuring that all information provided in relation to this grant application is kept confidential. During the assessment process however, the Mirboo North & District Community Foundation may need to collect, use and circulate information about your organisation and the project to its Board, officers and agents or external people to assist in assessing the grant application.

I give permission for the details of this application to be circulated to the individuals who are carrying out the assessment(Required)

Yes

I give permission to add contact details to Mirboo North & District’s Community Foundation mailing list(Required)

Yes

I confirm that our Organisation is following the Mirboo North & District Community Foundation’s Facebook page.(Required)

Yes

N/A

I confirm that the organisation has permission from the land-owner or manager to carry out the project and attach the written proof of same.(Required)

Yes

N/A

Written authorisation from the land-owner or manager

Max. file size: 128 MB.

I confirm that I am the President / Chair / Manager / of the organisation and authorised to sign this application.(Required)

Yes

N/A

That the President / Chair/ Manager of the organisation has authorised me to sign this application (written authorisation to be attached.)(Required)

Yes

N/A

Written authorisation from President / Chair/ Manager of the organisation

Max. file size: 128 MB.

I confirm that all details in this application are true and accurate and that I will notify the Mirboo North & District Community Foundation if there are any changes of circumstances that may affect this application:

Yes

SIGN APPLICATION

Signature(Required)

First Name Last Name

Position within organisation(Required)

Date(Required)

DD slash MM slash YYYY

GRANT APPLICATION CHECKLIST

Checklist(Required)

Received and read the “Community Grant Guidelines” and spoken with Executive Officer.

Prepared application form. Questions 1-6 and 10 should not exceed 250 words

Copy of TCC status (if applicable) has been provided

Certificate of Incorporation has been provided

Budget has been provided

Retained copy of your application

The declaration has been signed by an authorised member of the organisation or written authority for signatory has been given

Copy of most recent Annual Report or Financial Accounts are attached

Letter of consent / approval from the landowner in relation to the Project (if applicant is not owner).

Letters of support are included.

GRANT APPLICATIONS CLOSING DATE

Further information can be obtained from:
Ruth Rogan

Executive Officer

Phone 0418 301 092

Email info@mirboodistrictfoundation.org.au

Website http://www.staging-mndcf-staging.kinsta.cloud

The 2022 grant round closes on 30th September 2022.
No late applications will be accepted.

Mailed applications must be received by the relevant closing date.

Applications can be emailed to: info@mirboodistrictfoundation.org.au

Applications may be mailed to:

Executive Officer

Mirboo North & District Community Foundation

Community Grants Program

PO Box 327

Mirboo North, 3871

Victoria