community support levy charitable organisations … · web viewyour proposal detailed description...

Community Support Levy Charitable Organisations Grants Progam 2019-2020

Community Projects Grants Application Form

Department of Communities Tasmania

1. Applicant OrganisationApplicant OrganisationThe Applicant Organisation is the organisation that is applying for grant funding and will deliver the project or activity.

Name of Legal Entity: Common or Trading Name:

Applicant Organisation AddressAddress/PO Box: City/Suburb/Town: State: Postcode: Organisation Email: Organisation Phone: Organisation Chair: Name and Position

Applicant Organisation Contact OfficerName: Position/Role: Phone: Email: Legal Status of Applicant OrganisationThe Applicant Organisation must be an incorporated not-for-profit organisation whose dominant purpose is charitable. It will be responsible for the project and for appropriate acquittal of the funds. If an Applicant Organisation is not incorporated then it must seek sponsorship from an eligible incorporated charitable organisation.

☐ Incorporated Charitable Entity (attach Certificate of Incorporation)

☐ Not Incorporated Charitable Entity (complete section 1a Sponsoring Organisation)

☐ Other – Please specify

Applicant Organisation GST Registration Status☐ Registered for GST ☐ Not Registered for GSTApplicant Organisation’s Australian Business NumberLeave blank if the Applicant Organisation does not have an ABN.

ABN: Applicant Organisation Bank DetailsIf the Applicant Organisation is being sponsored by an incorporated charitable organisation, leave blank and complete Section 1a.

Bank:

CSL Charitable Organisations Grants Program 2019-2020 Community Projects Application Form | Page 1

Account Name:

BSB: Account Number:

1a. Sponsoring Organisation (if applicable)Only complete this Section if your organisation is not incorporated and you have agreed to be sponsored by an incorporated charitable organisation.

Sponsoring OrganisationThe Sponsoring Organisation receives the Community Support Levy grant funds and accepts the legal and financial obligations involved in accepting the grant including the transfer of funds to the grantee. The Sponsoring Organisation must provide a Certificate of Incorporation and an Agreement to Sponsor letter.

Name of Legal Entity: Common or Trading Name:

Sponsoring Organisation AddressAddress/PO Box: City/Suburb/Town: State: Postcode: Organisation Email: Organisation Phone: Organisation Chair: Name and Position

Sponsoring Organisation Contact OfficerName: Position/Role: Phone: Email: Legal Status of Sponsoring OrganisationThe Sponsoring Organisation must be an incorporated not-for-profit organisation whose dominant purpose is charitable. It will be responsible for the project and for appropriate acquittal of the funds.

☐ Incorporated Charitable Entity (attach Certificate of Incorporation)

☐ Other – Please specify

Sponsoring Organisation GST Registration Status☐ Registered for GST ☐ Not Registered for GSTSponsoring Organisation’s Australian Business NumberLeave blank if the Sponsoring Organisation does not have an ABN

ABN: Sponsoring Organisation Bank Details


Bank: Account Name:

BSB: Account Number:

2. Project OverviewAbout the Project

Project Title

Funding Request Up to $18 000 (ex-GST) per organisation.

Funding Request (ex-

GST)

GST(if

applicable)

Total Funding Request (incl

GST)

$ $ or N/A $ Organisations registered for GST should add this component to the middle column. e.g.$18 000 $1 800 $19 800

Organisations not registered for GST should leave N/A in the middle column. e.g. $18 000 n/a $18 000

Project Summary (max 25 words)Provide a brief useful working definition of your project or activity. It should be concise and descriptive.

Project Start Date and DurationProjects must be completed by 30 June 2021

Start Date:

Duration:

Target Group(s)The target group represents the people in the community your equipment purchase will support. Please see the Funding Focus section of the CSL Charitable Organisations Grants Program 2019-2020 Guidelines for more details.

☐ communities or groups in areas of low socio-economic status☐ communities or groups in rural or remote areas☐ vulnerable young people☐ vulnerable older people☐ culturally and linguistically diverse (CALD) communities or groups☐ people with disabilities or significant health issues (including mental health issues)☐ communities or groups with lower health and/or financial literacy☐ communities or groups addressing social isolation issues☐ communities or groups addressing alcohol and drug issues


☐ communities or groups addressing family violence issues☐ communities or groups addressing gambling issues.☐ other target group (please detail)

Additional Details (if applicable)


Where will the project be delivered?

The location refers to the site or region where your project or activity will be based. It does not refer to your office location. Tick any Local Government Areas (LGAs) that apply or tick State-wide for projects impacting all LGAs.

☐ Break O’Day ☐ Flinders ☐ Launceston

☐ Brighton ☐ George Town ☐ Meander Valley

☐ Burnie ☐ Glamorgan-Spring Bay

☐ Northern Midlands

☐ Central Coast ☐ Glenorchy ☐ Sorell

☐ Central Highlands ☐ Hobart ☐ Southern Midlands

☐ Circular Head ☐ Huon Valley ☐ Tasman

☐ Clarence ☐ Kentish ☐ Waratah-Wynyard

☐ Derwent Valley ☐ King Island ☐ West Coast

☐ Devonport ☐ Kingborough ☐ West Tamar

☐ Dorset ☐ Latrobe ☐ Statewide (all)


3. Project Description and ObjectivesYour ProposalDetailed description to support your application (500 words or less)Please link your proposal to the Funding Focus in the CSL Charitable Organisations Grants Program 2019-2020 Guidelines. Please address: Rationale – What is the community need for your project? Why is the project required? Outcomes – What benefit will be delivered for your target group or community? Activities – What will the project do? Scope – How many people from your target group benefit from your project and how will they be

involved? Community Links – How does the project connect with existing community services, networks and

resources? Evaluation – How will you measure whether the project is on time and on budget and if outcomes have

been achieved? Sustainability – How will the outcomes continue to benefit your target group after the project ends?


4. Assessment CriteriaAssessment Criterion 1

Demonstrate a strong need for the project within your target group or community

In responding to this criterion, please include: a description of the target group or community the extent of the problem you have identified how the problem relates to the Funding Focus for the CSL Grants Program


what services are already available to support the target group or community and whether there is unmet need that your project fills.

Assessment Criterion 2

Describe your project in detail and how it will be delivered, including innovative initiatives and links to existing community strengths, services and resources

In responding to this criterion, please include: a description and objectives of the project how the project will be implemented and delivered (including a project plan and


project budget) how you will engage with your target group or community how your project links with existing community strengths, services and resources how your project demonstrates innovation.


Describe your intended outcomes for your target group or community, how they will be delivered and how they will be sustained

In responding to this criterion, please include: what the intended outcomes will be


how the project activities will deliver the intended outcomes how the intended outcomes will benefit the target group or community how the benefits to the target group or community will be sustained after the project

ends.


Demonstrate your organisations capability to successfully deliver the project

In responding to this criterion, please include: a description of your organisations governance structure your project staffing profile a description of your organisations prior experience in delivering projects to your


target group or community a description of your organisations capability to meet the reporting requirements.

5. Normal Business How Does Your Project Differ from Normal Business?


CSL Grants Funding is not recurrent. CSL Grants will not be provided to fund projects or activities that your organisation delivers as part of its normal business (e.g. programs or activities that are already being delivered, core services, maintenance). Please indicate how your proposed project or activity differs from your normal business.

6. Past Project DeliveryPrevious Delivery of the ProjectHas a version of this project been delivered at any time in the past?

☐ Yes – Please provide details ☐ No

When was it delivered and how was it funded?

How is it different to the previous project and why is it being proposed for delivery again?


7. Organisational CapacityYour Organisation Please provide evidence to demonstrate that your organisation has the capacity to deliver the project and the project outcomes (e.g. delivery of previous projects/programs, staffing, experience, governance, quality and safety).

8. Other Funding SourcesDetails of other funding sources for the project (including pending grant applications)

Funding Body Funding

Project Title & Purpose Current Status


9. BudgetBudgetPlease provide a detailed and realistic project budget. If you do not have a project budget, the template below may be used as a guide. Add or remove rows as required.

Quotes or other evidence of costs should be provided for any actual project costs. Core business activities will not be funded. Eligible costs are new costs incurred in project delivery. Costs such as corporate costs and

salaries will not be funded unless they are new costs explicitly linked to project delivery.Salaries and Wages (e.g. FTEs, salary costs, on-costs) Cost ex GST Service Delivery (e.g. training, transport, communications, rooms, catering) Cost ex GST Equipment (any equipment critical to the project) Cost ex GST Corporate (e.g. payroll, accounts payable, recruitment) Cost ex GST Marketing (e.g. fliers, media, ads, invitations) Cost ex GST Miscellaneous Cost ex GST

TOTAL COST excluding GST $


10. Project WorkplanProject WorkplanOverview of the major activities and milestones for your projectPlease provide an estimate of the expected dates for your key project activities.Activity Expected Completion

Date (Month/Year)


11. Application AuthorisationsApplicant Organisation

We acknowledge that submitting an application for funding electronically warrants that we are duly authorised to submit an application on behalf of the organisation that is seeking a grant from the Charitable Organisations Grants Program 2019-2020. Further, we acknowledge that the absence of a handwritten signature in the application for funding does not invalidate the electronic submission. We also undertake to sign and forward a hard copy of this signature page, along with supporting documentation, where the application was lodged electronically.

Declaration and signature of two persons duly authorised to sign on behalf of the organisation.We declare that the information we have given on this form is complete and correct and that the group/organisation that we represent supports the project.

Authorised Officer 1 Authorised Officer 2

Signature(SIGN BY HAND)

Print name Position in organisation

Phone

Date

Sponsoring OrganisationDeclaration and signature of person duly authorised to sign on behalf of the Sponsoring Organisation (if applicable). Sponsoring Organisation

Signature(SIGN BY HAND)

Print name Position in organisation

Phone

Date


Sponsoring Organisations must also complete a ‘Letter of Agreement to Sponsor’ (example letter provided).


Submitting ApplicationsApplications close 5:00pm Friday 29 November 2019.

Late applications will not be accepted.

Submit by email to: [email protected]

Please note, applications must be submitted by e-mail.

It is recommended that your keep a copy of your application for your own records. Applicants will receive a confirmation of receipt e-mail notification upon submission. This should be kept as proof that the application was e-mailed before the closing date.

For information about this grants round, including funding focus, organisation eligibility, funding preferences and Frequently Asked Questions, please see the Community Support Levy Charitable Organisations Grants Program 2019-2020 Guidelines.

Application Checklist (do not submit)

Document CompletedA completed CSL COGP 2019-2020 Application Form, including: ☐ Application Form

- A Budget for this project, including quotes for actual project costs ☐ Budget inc Quotes

- A signed Application Authorisations page

☐ Signed Authorisation Page

A Certificate of Incorporation (for your organisation or your Sponsoring Organisation)

☐ Certificate of Incorporation

For organisations applying under a sponsorship agreement:An Agreement to Sponsor letter(example letter provided)

☐ Sponsor Letter

For applicant use only – do not submit with application

CSL Charitable Organisations Grants Program 2019-2020 Small Equipment Application Form | Checklist

mailto:[email protected]

Example of an Agreement to Sponsor LetterFor the purpose of the Charitable Organisations Grants Program, an eligible sponsoring organisation is defined as an organisation that is a not-for-profit ‘incorporated entity’ and its dominant purpose is charitable. The Sponsoring Organisation receives the Community Support Levy funds and will accept the legal and financial obligations involved in accepting the grant including the transfer of funds to the grantee. The Sponsoring Organisation must provide a signed letter agreeing to the sponsorship (example below) and sign the Application Form authorisation page.

This letter must be provided on the Sponsoring Organisation’s official letterhead.

DateChair, Charitable Organisations Grants Program Advisory Groupc/- Gambling Support ProgramDepartment of Communities TasmaniaGPO Box 65Hobart TAS 7001

Dear Sir/MadamOur organisation is an incorporated charitable organisation and is prepared to act as the sponsoring body for the [name of applicant organisation] should it be successful in obtaining funding from the 2019-2020 Community Support Levy Charitable Organisations Grants Program, to undertake [name of proposed project].We are aware that the grant will be paid to our organisation and we accept the legal and financial obligations involved in accepting the grant.

Yours sincerely

[Name][Position in organisation]

CSL Charitable Organisations Grants Program 2019-2020 Small Equipment Application Form | Letter

For applicant use only – do not submit with application

CSL Charitable Organisations Grants Program 2019-2020 Small Equipment Application Form | Letter

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