Online Form - Community Assistance Program Application

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Having the following documents on hand will assist with the completion of this application.

Required Documents

Certificate of Incorporation
Certificate of Current Public Liability Insurance
Copies of Quotations (for each item in project budget)

Required Documents (Revitalisation Grant Only)

Site Plans / Building Plan
Development Application
Building Licence

Save Your Progress

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Note: Incomplete forms are kept for a period of 14 day(s), after this time the system will automatically delete your response.

Before proceeding with your application

I/we have*

Read the Community Assistance Program Guidelines

I/we have*

Spoken directly with the Community Development Officer

I/we have*

Not received any funding from the City of Busselton this financial year

Type of Grant

Please select the grant you are applying for*

Community Assistance Grant
Revitalisation Grant
Revitalisation Grant Plus*

*If Revitalisation Grant Plus, specify the date your project was discussed with a City Officer

Applicant Details

Name of organisation applying*

Postal address*

Please upload a current certificate of Public Liability Insurance*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Is your organisation registered for GST?*

YesNo

Does your organisation have an ABN?*

YesNo

Please provide your ABN

What is the name of your organisation’s governing or regulatory body?

Number of active members:

Number of social members

Number of other members

Organisation classification*

Incorporated Group
Not for Profit Organisation

If applicable, please provide your Incorporated number, found on your Certificate of Incorporation

Certificate of Incorporation

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please upload copy of minutes of organisation’s most recent Annual General Meeting

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Application Contact Person

Who will be the main point of contact during the application process?

Name*

Position*

Phone*

Email*

Project Details

Project title (This will be used throughout the assessment process)*

Detailed description of project*

Expected project start date*

Expected project completion date*

Location of project

Street Address:

City:

State:

Post Code:

Country:

Copy of minutes of organisation’s meeting endorsing the project and the application

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Evidence of landowner’s consent (If applicable)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Project Budget

Total cost of project*

Details of other funding contributions (Name of contributors and amount contributed)

Details of any previous funding received from City of Busselton (Date and amount received)

Financial contribution from organisation

In-kind contribution from organisation at $35 per hour (Not to exceed financial contribution, see example format below)*

Example: 20 Hours at $35, Total = $700

Total amount being requested from the City of Busselton for this project (Not to exceed 60% of total cost of the project)*

Please provide a simple document outlining the breakdown of project costs (See example below)*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Total Cost of Project	$4,000
Project Cost Breakdown (List each item of project and cost)	Item	Cost
	Item 1 Painting	$ 1,000
	Item 2 Roof repair	$ 2,000
	Item 3 Purchase of printer	$ 1,000
	TOTAL: *Must equal total cost of project	$4,000

Can the project proceed if only partial funding is granted?*

YesNo

Quotations

It is a requirement of this application that each item referenced in the 'Project Cost Breakdown' have (2) quotes sourced and submitted with the application.

Project item 1 (Quote 1)*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Project item 1 (Quote 2)*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Project item 2 (Quote 1)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Project item 2 (Quote 2)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Project item 3 (Quote 1)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Project item 3 (Quote 2)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Rationale

Does the project align with any club, association or government strategies or plans?*

Please provide Organisation Strategic Plan (If available)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

What community need does the project meet?*

How was the community need identified?*

How many people will directly benefit from the project?*

How many people will indirectly benefit from the project?*

What community sectors does the project primarily target? (Select all that apply)*

AgedDisadvantagedEarly Childhood / FamilyEnvironmentSports & RecreationYouth

Coordination

Who will be responsible for delivery of the project?*

What other organisations will benefit or be affected by your project?*

Have you consulted with these other organisations in regard to this application?*

YesNo

Please attach letters of support

Max File Size: 10.00 MB
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Sustainability

How will the project affect the future sustainability of your organisation?*

Will there be any ongoing costs of the project?*

YesNo

Upload supporting Documents

Letters of support for this project (If available)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Other documents in support of application (If available)

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Revitalisation Grant

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Online Form - Community Assistance Program Application

Apply Now

Required Documents

Required Documents (Revitalisation Grant Only)

Suggested Supporting Documents

Save Your Progress

Before proceeding with your application

Type of Grant

Applicant Details

Application Contact Person

Project Details

Project Budget

Quotations

Rationale

Coordination

Sustainability

Upload supporting Documents

Revitalisation Grant

City of Busselton

Associated Websites