Townsville 150 Grant. This is a sample form only. Please use the online application form to submit your application.

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1 Townsville 150 Grant This is a sample form only. Please use the online application form to submit your application Applicant details Applicant organisation or individual name (as shown on legal documents) Street address Website address Is your postal address different to the above? PO box number Contact person for this application Applicant contact name Position in organisation Contact number address Alternate contact name Position in organisation Contact number address

2 Briefly outline the nature of your organisation and its primary purpose (Not required for applications from individuals) Does your organisation have a constitution/ strategic plan/ business plan? Please upload a copy Eligbility Requirements In order to be considered eligible for funding you must fit one of the following applicant categories, please select the one that applies to you and provide the appropriate information / attachments. An Incorporated Community Organisation / Service Organisation A Business or Commercial Entity (whose project is able to satisfy the program's funding and preference criteria A School or Government Agency (only for activities with a wider community ) An Individual with an ABN An Individual (with no ABN) who is being auspiced by an eligible community organisation. I do not meet any of the above I am a community group being auspiced by an eligible Community Organisation WHAT IF I M AN INDIVIDUAL WITH NO ABN? Individuals who do not have an ABN will need to get an ABN or approach a community organisation to auspice the project. The incorporated organisation takes full responsibility for the legal and financial accountability of the proposed project and will undertaking the project in line with their own professional capacity. I.e. projects or concepts that are amateur in nature will not be accepted. You will require a copy of the auspicing organisations Certificate of Incorporation or copy of their Certificate of Registration of Company, limited by guarantee. You will also need to provide a copy of a written Agreement from the auspicing organisation, accepting full legal and financial accountability for the project. WHAT IF YOUR ORGANISATION IS NOT INCORPORATED? Applicants who are not incorporated or registered companies with limited liability will need to seek incorporation or approach a community organisation to auspice the project. The incorporated organisation takes full responsibility for the legal and financial accountability of the proposed project. You will a copy of the auspicing organisations Certificate of Incorporation or copy of their Certificate of Registration of Company, limited by guarantee. You will also need to provide a copy of a written Agreement from the auspicing organisation, accepting full legal and financial accountability for the project. Is the Incorporated Community Organisation / Service Organisation registered for GST?

3 Please upload a copy of your Certificate of Incorporation your Copy of Certificate of Registration of Company, limited by guarantee Is your Business or Commercial Entity registered for GST? Is your School or Government Entity registered for GST? Are you registered for GST? Auspice Organisation Contact Details Name of auspice organisation Street address Website address Is your postal address different to the above? PO box number Auspice organisation contact details Contact person Mobile number

4 address Does the auspice organisation have an ABN? Please enter auspice organisation's ABN? Is the auspice organisation registered for GST? Please upload the following documents: Please upload a copy of your auspice organisation's Certificate of Incorporation or Certificate of Registration of Company, limited by guarantee. Copy of written confirmation (letter/ ) from auspice organisation agreeing to auspice this application. How would you identify with the following eligible applicant categories? Organisation type Not-for-profit Government Non-government Business Charity Educational institution Other Briefly outline the nature of your organisation and its primary purpose Is your organisation incorporated? *WHAT IF YOUR ORGANISATION IS NOT INCORPORATED OR DOES NOT HAVE AN ABN? Non-incorporated organisations (not including businesses) considering applying for funding under this initiative should seek incorporation or approach an incorporated community organisation to auspice the project. The incorporated organisation takes full responsibility for the legal and financial accountability of the proposed project. Please attached a copy of the certificate of incorporation Does your organisation have public liability insurance? Please attach a copy of your public liability insurance Is your organisation registered for GST? Does your organisation have an ABN?

5 Does your organisation have a constitution/ strategic plan/ business plan? Please attach a copy Project/ Activity Details Location of project/ event (venue, address and postcode) Grant amount requested (how much funding you are requesting from Council to be paid in the 2015/16 financial year) If your project/activity/event is to be held in a council venue or park, are you seeking the waiver of hire fees for this council venue or park? Please outline below any associated hire fees you are requesting and include a copy of the hire agreement from council. Please note that any activities taking place in the CBD will have hire fees automatically waived. Please upload a copy of the Venue Hire Agreement or written/ quotation obtained from Townsville City Council How does your project or event align with council's purpose of the program to celebrate the 150th anniversary of the city? (Please choose more than one where applicable) Support innovative and creative ways of sharing the history of Townsville with the local community. Recognise the role history plays in facilitating learning and creating an informed community. Increase the public s awareness of the historical information and objects held in the community. Recognise To Provide a link between Townsville s past and Townsville s future. Encourage community participation in attending programs, projects, events, activities and celebrations relating Other (Please give details): How does your project or event align with the objectives of the Townsville 150th Anniversary Grant Program? (Please choose more than one where applicable) Support innovative and creative ways of sharing the history of Townsville with the local community. Recognise the role history plays in facilitating learning and creating an informed community. Increase the public s awareness of the historical information and objects held in the community. Recognise To Provide a link between Townsville s past and Townsville s future. Encourage community participation in attending programs, projects, events, activities and celebrations relating Other (Please give details): Does the application meet the following eligibility criteria? Relevant to Townsville s 150th Anniversary of the city s establishment. Demonstrate the grant will be used for community benefit with a public outcome. Occur within the Townsville local government area. Activities are managed by an incorporated organisation and are able to accept any legal and financial responsibility and be financial viable.

6 Free from outstanding debt to Townsville City Council and outstanding grant acquittals of previous Council grants. Delivery will take place in the 2016 calendar year. Provide full details of the project or event which you are seeking funding: (Please describe the project or activity to take place including any details you feel will explain to council the purpose of what you are doing, and why council support is justified in the context of T150 celebrations) Further program project details (Please attach quotes for the amounts requested) Is this a new or existing initiative? What is the total cost of the project? How much are you/ your organisation contributing? How many people do you anticipate will attend or take part in the project/ event? How many local residents are expected to take part? How many visitors not from Townsville are expected to take part? Is there an event entry fee? What is the entry fee (per person) for the event? Who are the target groups for your project/ organisation? Children (under 12 years) Young people (12 to 17 years) Seniors (60+ years) People from culturally diverse backgrounds Aboriginal & Torres Strait Islander people People with a disability Low income families Families No specific target group (general community) Other (please specify) What other groups will be included in your initiative? What other groups are you working with? Quotations

7 We encourage applicants to include applicant s quotations to support their application. These quotations can include equipment hire, stage hire, marketing /promotional items. (Please scan and upload your quotations as a single document) Do you have quotations? Quote attachment Budget overview The budget template can be downloaded here. This is a basic budget template. Please attach a separate budget outlining projected income and expenditure if the template is not suitable. Please complete and attach the budget template Has the organisation previously received council support? Funding year Amount funded Funding year Amount funded Funding year Amount funded Funding year Amount funded Supporting documentation and letters of support You can upload further documents here to support your application for funding. You can provide letters of support for your project from the community (this may be from other organisations, project attendees or other funding bodies). You do not need to attach a letter of support from a council representative. Where possible, please compile the attachments and upload them as one document. Letters of support for your project from the community (this may be from other organisations, project attendees or other funding bodies). You do not need to attach a letter of support from a council representative. lease upload a copy of your organisation's or the auspice organisation's Public Liability Insurance / Certificate of Currency that will be used to cover your event/project Authorisation and Declaration This application is to be signed by two executive officers of the applicant organisation.