cgp events and activities_report form - omi · web viewcommunity grants program report form events...
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Community Grants ProgramReport Form
Events and Activities (up to $5000)
All Community Grants Program (CGP) recipients are required to submit a project report, including a certified or audited financial statement as applicable, within 60 days of event/activity completion.
If an extension to the acquittal date is required, please contact the Office of Multicultural Interests (OMI) Grants Officer.
The OMI Grants Officer can be contacted by:
Phone: (08) 6552 1619Email: [email protected]
June 2016
Grantee organisation details
Organisation name [Click here to enter the organisation name.]
Street address [Click here to enter street address.]
Suburb [Enter Suburb.] Postcode [Enter postcode.]
Postal address Please tick if same as above ☐
[Click here to enter postal address.]
Suburb [Enter suburb.] Postcode
[Enter postcode.]
Contact person (Project contact)
Title Mr ☐ Mrs ☐ Ms ☐ Dr ☐
Name [Click here to enter Contact Name.]
Position [Click here to enter Contact Position.]
Telephone Business: [Enter phone.] Mobile: [Enter mobile.]
Email address [Click here to enter email address.]
Organisation contact (CEO, Chair, President)
Title Mr ☐ Mrs ☐ Ms ☐ Dr ☐
Name [Click here to enter Organisation contact name]
Position [Click here to enter Organisation contact position]
Telephone Business [Enter phone] Mobile [Enter mobile]
Email address [Click here to enter email address]
Was this project auspiced? Yes* ☐ No ☐
* If this project was auspiced, the auspicing organisation’s legally authorised officer must sign the declaration for this report.
Event/activity summary
Event/activity title [Enter event/activity title]
Event/activity location [Enter event/activity location]
Event/activity date(s) [Enter key dates—where multiple days]
What was the total cost of the event/activity? (GST exclusive)
[Enter total cost of the event/activity ]
What was the CGP grant amount? (GST exclusive)
[Enter the CGP grant amount]
Event/activity details
In 150 words or less, provide an outline of the event/activity that was delivered:
[Outline the event/activity that was delivered]
Grant criteria and strategic focus areas
Please select the grant criteria and strategic focus area that applied to your event/activity from one or more of the following:
it strengthens the capacity of culturally diverse communities ☐ it facilitates full participation by culturally diverse communities in social,
economic, cultural and civic activities ☐ it develops intercultural understanding and promotes the benefits of Western
Australia’s cultural diversity ☐ it builds the capacity of one or more culturally diverse community
organisations/associations to deliver positive outcomes for community
members, including civic and community participation ☐ it is an event or activity celebrating Harmony Week. ☐
In 150 words or less, describe how your event/activity addressed your selected grant criteria:
[Enter how your event/activity addressed your selected grant criteria]
Event/activity reach
Actual number of participants/audience/spectators
Age group Male participants
Female participants
Audience/spectators
Children 12 years and under [Enter number.] [Enter number.] [Enter number.]
Youth 13–17 years [Enter number.] [Enter number.] [Enter number.]
Adults 18–54 [Enter number.] [Enter number.] [Enter number.]
Seniors 55 and over [Enter number.] [Enter number.] [Enter number.]
TOTAL [Enter number.] [Enter number.] [Enter number.]
Actual number of personnel/partnerships
Who Number Roles
How many paid staff [Enter number.] [Enter role]
How many volunteers [Enter number.] [Enter role.]
How many partner organisations [Enter number.] [Enter role.]
How many participant organisations [Enter number.] [Enter role.]
Actual number and type of activities or events
Activity type Number Venue
Enter activity type [Enter number.] [Enter venue]
Enter activity type [Enter number.] [Enter venue]
Enter activity type [Enter number.] [Enter venue]
Enter activity type [Enter number.] [Enter venue]
Enter activity type [Enter number.] [Enter venue]
Promotional and media coverage
Coverage Yes/No Detail—for example: 1 x media release, 1 x advert in AB newspaper, etc
Newspaper Enter Y/N] [Enter Detail]
Advertisements Enter Y/N] [Enter Detail]
Flyers Enter Y/N] [Enter Detail]
Radio Enter Y/N] [Enter Detail]
Social media Enter Y/N] [Enter Detail]
OMI website Enter Y/N] [Enter Detail]
OMI signage Enter Y/N] [Enter Detail]
Event/activity success
In 150 words or less, report on how the event/activity met the project success measures outlined in the grant agreement:
[Report on the project success measures outlined in the grant agreement]
In 150 words or less, provide an overview of the lessons learned in delivering the event/activity—what worked well and what could be improved?
[Enter the lessons learned—what worked well and what could be improved]
Certified Financial Statement
Income Amount ($)
CGP amount [Enter amount]
Other income sources Amount ($)
[Enter income source] [Enter amount]
[Enter income source] [Enter amount]
[Enter income source] [Enter amount]
In-kind contributions Amount ($)
[Enter in-kind contribution] [Enter amount]
[Enter in-kind contribution] [Enter amount]
[Enter in-kind contribution] [Enter amount]
TOTAL [Enter amount]
Expenditure items Amount ($) Funding organisation
[Enter expenditure item] [Enter amount] [Enter funding organisation]
[Enter expenditure item] [Enter amount] [Enter funding organisation]
[Enter expenditure item] [Enter amount] [Enter funding organisation]
[Enter expenditure item] [Enter amount] [Enter funding organisation]
[Enter expenditure item] [Enter amount] [Enter funding organisation]
[Enter expenditure item] [Enter amount] [Enter funding organisation]
[Enter expenditure item] [Enter amount] [Enter funding organisation]
TOTAL [Enter total]
DECLARATION
I certify that the information provided is to the best of my knowledge, true and correct.
I, the undersigned, hereby certify that the funds have been used for the purposes for which they were granted by the Office of Multicultural Interests.
Name: [Enter Name]
Position: [Enter Position]
Organisation: [Enter organisation]
Date: [Enter todays date]
When you have completed this form please print it and sign in the box below.
Signature:
Event/activity report checklist Ensure these actions have been completed and attach the relevant documents before the project report is submitted.
1. Certified financial statement is signed by an authorised office bearer (applicant
organisation or its auspice where applicable) ☐2. Copies of promotional materials and any photos taken for reporting purposes only ☐3. Media statement and newspaper clippings ☐4. Photos (with appropriate photo permissions) that may be placed on OMI's website for
promotional purposes ☐5. Retained a copy of the signed project report ☐
Event/activity report submission
Reports can be submitted by:
EmailSend your report and supporting materials to:
Grants [email protected]
PostSend your report and supporting materials to:
Grants OfficerOffice of Multicultural InterestsGPO Box R1250PERTH WA 6844
DeliveredEnclose your report and supporting materials in an envelope and deliver to:
Grants OfficerOffice of Multicultural InterestsLevel 2, Gordon Stephenson House140 William StreetPERTH WA 6000
Contact information
Grants OfficerOffice of Multicultural InterestsPhone: (08) 6552 1619Email: [email protected]