1.1 Name of Incorporated Sponsor Organisation

If the applicant is not incorporated, an incorporated sponsor organisation is needed to accept the funding.

1.2 Name of Applicant Organisation/Individual

Provide if different from the sponsor organisation

1.3 Name of Chairperson/CEO/Director

1.4Contact Person for Project

1.5 Description of Applicant Organisation

Describe the background and purpose of the organisation requiring funding. Include the type of service, who supported is provided to, is it community based etc.

2.1 Name of Project

2.2 Project Description

Describe the project or program for which support is requested.

2.3 Type of service/activity/program provided.

2.4 Amount of funds requested

2.5 Who will benefit from this Project?

Eg individuals/families, gender, age group, people with disabilities etc

2.6 Indicate the number of people who will be assisted by the Project

2.7 What will be the results of the project and for the people to be assisted?

2.8 Provide a list of goals for the project and a time line for its achievement

2.9 Geographic area covered by the project

2.10 Who will supervise the project?

Name, Position held

2.11 How many paid staff and volunteers will be involved in the Project?

2.12 Briefly describe the role of paid staff and volunteers

2.13 Support for the Project

Provide information or evidence for the following:

(a)The need for the Project and the needs of the people to be assisted. A statement of need from the participant, advocate or organisation should be included.

(b)How the Project is linked to the community?

2.14 Evaluation of the Project

Indicate how the project will be evaluated

3.1 Details of Grant sought/Project Expenditure

List items for which grant is sought

(eg. Equipment, staff training, transport, project staff, postage, food/meals, one-on-one support)

3.2 Total project Expenditure

3.3 Total project Income

3.4 In-Kind Support

Please list any in-kind support you expect to be provided to the project

(eg paid staff, volunteers, facilities, equipment, venues)

4.1 Please attach a copy of the following to the application form:

Certificate of incorporation of your organisation

Audited financial statements from the last two financial years

Documentation that the organisation has made a formal decision to apply for the grant (eg. copy of Board/Management Committee meeting)

Any other information to describe or support your project

4.2 Have you applied elsewhere for funding in relation to this Project?

If yes, please give details.

4.3 As a condition of funding for approved projects, organisations are requested to acknowledge the funding body in their promotional material and to co-operate with promotions which may be organised by Cando4kids Townsend House.

4.3 Signatories

This application must be signed by 2 persons authorised by the sponsor organisation to apply for the grant. These should be Executive members of the Board/Management Committee and/or management staff.