Online Form - Signature Event Grants

Name of Organisation *

Name of Contact Person *

Postal Address *

Town *

Email *

Mobile *

Name of President:

Name of Secretary

Is your organisation incorporated?

YesNo

Incorporation Number

ABN

BSB *

Account Number *

Registered for GST *

YesNo

Has your organisation received Council funding this financial year? *

YesNo

If the organisation has previously received Council funding please provide details below of the year funding received, the amount of funding received and a brief description of the project

Project/Activity Name *

Project /Activity Start Date *

Project/Activity Completion Date *

Amount Requested (maximum amount is $10,000) *

Estimated Project/Activity Cost *

Project/Activity Description (briefly describe the project/activity for which you are seeking funding) *

Estimated number of people who will benefit from the project *

What percentage of participants will be from the Shire of Ashburton? *

Please describe how the community will benefit from your project/activity *

List any other groups or organisations who will be contributing to the planning and implementation of your project

Project budget

Project/activity income (amount excluding GST) *

Amount CASH being requested from the Shire of Ashburton *

Amount IN-KIND being requested from Shire of Ashburton *

Other Grants Received *

Contributions from other groups/business *

Any other income or contributions?

YesNo

Total income *

Project Expenses

Expenses : Please list project expenses (amount excluding GST) *

Total expenditure

Supporting documentation

Quotations

Other relevant files

Current Public Liability Insurance Certificate (Certificate of Currency)

Provide details on how the event will be promoted to the community and how you intend to acknowledge the Shire of Ashburton. You will need to demonstrate how the Shire will be acknowledged for their contribution as part of the grant acquittal. *

Name of Authorised Representative *

Position *

I have read and understood the Funding Guidelines in Section 1 of this application and declare that; *

The funds requested would be used only for the purpose described. If the funds are not used, or the total funding amount is not used on the described project, they will be returned immediately to the Shire of Ashburton
The information given on this form is complete and correct
I have listed all relevant income and expenditure
We have reviewed the Shire of Ashburton Disability and Inclusion Plan before submitting this application
I/We authorise the Shire of Ashburton to reproduce the images taken for promotional purpose including web, newspaper, social media and other forms of communication materials if required.