2016 Community Development Funding Application

Transcription

1 2016 Wentworth District Capital Limited Community Development Funding Application Page Community Development Funding Application APPLICATION CHECKLIST THIS MUST BE COMPLETED Please ensure that you have ticked of each of the following grant application funding criteria:- FORMAL QUOTES - one, and preferably two, for each budgetted item to be purchased or work to be completed by outside agencies. CURRENT BUSINESS PLAN - a copy of your Organisation s current business plan must be included if your application exceeds $20,000. ANNUAL REPORT (2015) INCLUDING FINANCIAL STATEMENTS AND WHERE APPLICABLE AUDITOR S/REVIEWER S REPORT - a copy of your most recent must be attached. LETTERS OF SUPPORT, PLANS etc - attach any letters of support, plans etc. which you believe will assist us in evaluating your application for funding and any additional information that you believe may be relevant. COPY OF CURRENT BANK STATEMENT COPY OF WENTWORTH SHIRE COUNCIL DOCUMENTATION (if applicable) COPY OF CURRENT CERTIFICATION OF REGISTERED CHARITY (if applicable) A COMPLETED STATEMENT OF SUPPLIER FORM IF REQUIRED (contact Jill Davidson or Rob Verstappen for copy of form)

2 2016 Wentworth District Capital Limited Community Development Funding Application Page Community Development Funding Application CLOSING DATE : Friday 15 April 2016 Important information for Application completion: Only typed applications will be accepted. All applications must contain at least one, and preferably two, formal quotes for each budgetted item to be purchased or work to be completed by outside agencies. A copy of your Organisation s current Business Plan must be included if your application exceeds $20,000. A copy of your most recent Annual Report (2015), including Financial Statements where applicable and Auditor s/reviewer s Report, must be attached. Attach any letters of support, plans etc. which you believe will assist us in evaluating your application for funding and any additional information that you believe may be relevant. Taxation Requirements To comply with Australian Taxation Legislation and to preclude implementation of Withholding Tax provisions, community groups and organisations applying for Community Development Grant Funding must provide either an Australian Business Number (ABN) or complete a Statement by Supplier form (reason for not quoting an Australian Business Number (ABN) to an enterprise) available from the Australian Taxation Office (website) or Wentworth District Capital Ltd (WDCL) who will forward this form to successful applicants that have indicated that their organisation does not hold an ABN number. The Statement by Supplier Form is to be completed and returned to WDCL prior to any payment being made. Goods & Services Tax (GST) Not for profit community organisations must be registered for the GST if their annual turnover is $150,000 or more. However some community organisations with lower turnover may have chosen to register in order to claim back the GST they pay on purchases involved with running their organisation. Grants and Sponsorships paid to organisations that are registered for the Goods and Services Tax will be subject to GST. Where your organisation is registered for GST, funding for successful applicants that are registered for GST will be Grossed up to include the GST amount. WDCL will issue all successful applicants with a recipient created Tax Invoice. When completing the budget section of the application form (Section 10) whether or not your organisation is registered for GST, all monies shown should be GST excluded.

3 2016 Wentworth District Capital Limited Community Development Funding Application Page 3 Name of Organisation:. Project Title:. Postal Address:... Contact Person/s: Name: Position.Phone ... Name: Position.Phone ... Are you a Deductible Gift Recipient or Registered Charity? Yes / No If yes, please provide copy of current certification. Is your group incorporated? Yes / No Incorporation Number:. ABN:.. Are you registered for Goods & Services Tax (GST)? Yes / No Is your Organisation a customer of the Wentworth & District Community Bank Branch Bendigo Bank? Yes / No

4 2016 Wentworth District Capital Limited Community Development Funding Application Page 4 PROJECT INFORMATION DOLLAR VALUE OF FUNDING SOUGHT: $ What does your organisation do? (Please provide information on mission statement, founding date, major programs, attributes, number of members, staff and/or volunteers.) 2. Please fully outline how your organisation, committee and/or members have supported the Wentworth & District Community Bank Branch (whether staff and/or volunteers are customers of the WDCBB, does your organization bank with the WDCBB, how does your organization actively encourage community members to bank with WDCBB) 3. Please fully outline your proposed project, including location. (What particular need will it meet, who will benefit, where will your proposed project be located) 4. Please advise how many people in the community this proposed project/venture/facility will affect/assist (also identify/include visitor numbers, how many people are affected both directly and indirectly) 5. Please detail fundraising efforts and/or contribution to be made by your organisation towards the project? Other Partner organisations? (What is the percentage of the project that will be self-funded by your organisation, list other partner organisations, list fundraising events/promotions, include Federal/State/Local Government funding sought, other stakeholders involved with the project)

5 2016 Wentworth District Capital Limited Community Development Funding Application Page 5 6. How will your organisation manage this project? (Will an outside contractor be used, will this be undertaken through Wentworth Shire Council, is it to be selfmanaged). 7. What is your projected time frame for commencement and completion of your project? 8. Is the proposed grant expenditure to be applied outside of the Wentworth Shire and if so, what proven benefits will be available to Wentworth Shire residents? (Will the project include/assist residents in Wentworth Shire). 9. Has your Organisation previously received Wentworth & District Community Bank Branch Bendigo Bank funding? If so, please complete details below. Year Project Title Funding Received $ Evaluation Form returned Y/N 10. Please complete the table below to fully outline where project funds will come from, and how they are budgeted to be expended. Refer Attachment 1 for Example. Budgetted Item Community Bank Funding Sought Your Organisation s Contribution Third Party Contribution Direct In-kind Direct In-kind Total Cost Excluding GST TOTAL

6 2016 Wentworth District Capital Limited Community Development Funding Application Page 6 Please provide notes below to fully clarify above table. 11. Please outline any promotional opportunities your Project / Event may provide for the Wentworth & District Community Bank Branch. (Such as signage, media coverage and/or exposure (radio, television), brochures, advertising, householder drop, FaceBook/twitter inclusion, newsletters, etc) 12. Is the Community Bank funding catalytic to the project going ahead? YES / NO

7 2016 Wentworth District Capital Limited Community Development Funding Application Page Conditions of the Grant We, being authorised officers of the organisation in making this declaration, confirm and agree to the following:- a) The information given in this application, including any attachments hereto are true and correct in every particular. b) As the level of funding to be provided by WDCL is yet to be determined, we the applicant / grantee agree to allow WDCL to issue us with a Recipient Created Tax Invoice (RCTI) for any taxable supplies it makes in relation to the proposed project/activity. c) That any monies received from WDCL must be spent on the approved activity as outlined in this Community Development Funding application. d) Make appropriate public acknowledgment of the Wentworth & District Community Bank funding source / sources for the project. e) Any monies not expended on completion of the project will be returned to WDCL, to be once again pooled and made available for other worthy community funded projects. f) To provide WDCL with a completed evaluation / project acquittal report form detailing that the monies have been expended in accordance with this funding application. g) That failure to comply with these conditions may preclude your organisation from accessing further grant funding in the future. h) To indemnify and keep indemnified and to hold harmless, WDCL, its servants and agents and each of them from and against all actions, costs, claims, charges, expenses, and damages whatsoever which may be brought or made or claimed against them or any of them arising out of or in relation to a community project or event. i) We understand that any variation from the above conditions will require negotiation with WDCL s Grants and Sponsorship committee. To be signed by two different signatories on behalf of the applicant organisation. (signatories must be over 18 years of age) Name: Position Held: Signature: Date: Name: Position Held: Signature: Date: Return this application together with relevant attachments to Rob Verstappen or Jill Davidson: By admin@wdcl.com.au By mail or hand delivery: Adelaide Street, Wentworth NSW 2648 If you have any queries regarding the form please telephone Rob or Jill

8 2016 Wentworth District Capital Limited Community Development Funding Application Page 8 Attachment 1: EXAMPLE ONLY: Community Development Funding Application Community Bank Funding Sought Wentworth District Childcare Centre $610,000 Your Organisation s Contribution Third Party Contribution Total Cost Direct In-kind Direct In-kind Budgeted Item Feasibility, Plans & Permits $20,000 $20,000 Site Preparation $25,000 $25,000 Construction $15,000 $335,000 $350,000 Fit Out $15,000 $100,000 $115,000 Land $100,000 $100,000 TOTAL $20,000 $15,000 $15,000 $435,000 $125,000 $610,000 Please provide notes below to fully clarify above table. Site preparation $25,000 in kind labour donation from local Dig Deep earthmoving contractors Quote attached. Construction funding sourced from Kevin 07 Ready Grants Program $335,000 approval letter attached. Additional $15,000 by volunteer labour for painting & decorating Estimations of dollar value attached. Community fundraising efforts $15,000 towards fit out Copy of Bank statement attached. Wentworth Shire Council Land donation $100,000 Copy of Shire undertaking attached.