Online Form - Community Growth Fund Application Application form for the 2023/24 round of the Shire of Chapman Valley's Community Growth Fund. CLOSING DATE: 4PM FRIDAY 17 MARCH 2023 Please read the guidelines before completing this form. Please fully complete the form to ensure your application can be considered. Name of Organisation or Individual * Contact name: * Contact address: Contact number: * Email address: * Organisation type: * Not for ProfitIncorporatedIndividual How many people participate in your organisation: ABN: Brief description of your organisation or individual background if individual applying * YOUR PROJECT Project title * Briefly explain your project: * Project location: * Project dates: * Total project cost: $ * How much funding are you applying for: $ * Please list a breakdown of proposed expenditure for grant amount requested: * Are you expecting any other funding for your project (your organisation contribution, sponsorship, other grants) * YesNo Please list additional funding sources: In-kind contribution (volunteer time @$30 per hour): BANKING DETAILS Account name: * BSB: * Account number: * Does your organisation have the ability to fund this project upfront and receive grant funding through reimbursement? * YesNo Do you require the Shire of Chapman Valley to auspice your grant funds? * YesNo GENERAL DETAILS Have you included a quote with your application * YesNo If no, why not:: Is the project subject to an existing management license or similar arrangement? * YesNo Is the project subject to a Statutory/Permit/ Approval (e.g. Building, Planning, Event) * YesNo Is the project undertaken on Shire of Chapman Valley owned property? * YesNo Are you registered for GST? * YesNo Do you have public liability insurance? If yes, please attach a copy of 'Certificate of Currency' * YesNo Have you applied for funding from the Shire for this project previously? If yes, what year * YesNo Please enter which year and project: Have you received a grant in the past? If yes, please detail * YesNo Please detail: Is this project dependant on Shire funding to proceed? * YesNo Does your project include other local organisations? * YesNo Please list other organisations: Do you agree to acknowledge the Shire's contribution to your project in all media, promotional documents and visual signage? YesNo Please select a project catergory: Select an Option Crime Prevention & Community Safety Monuments Arts, Culture and Entertainment Disability Services Youth and Family Services Seniors Event Management & Sponsorship Natural Environment and Cultural Heritage Tourism & Promotion Sport & Recreation Health Events or People Upgrading Community Facilities Skill and Capacity Building APPLICATION QUESTIONS How will your project benefit the local community? * Please describe how the outcomes of your project will be measured? * How does your project meet the assessment criteria? (Section 7, CGF operating procedures document) * Please upload relevant quotes and attachments for your appliction Maximum size of ALL attachments is 976.56 MB Please upload relevant attachments for your application Maximum size of ALL attachments is 976.56 MB DECLARATION . * The information in this form is correct and any grant received will be spent on the project specified.All Shire approvals for this project will be in place prior to the commencement of the project.Acknowledgment will be given of Shire of Chapman Valley support for this project in any publicity, images, or website material.I give permission for use of images and media promotion by the Shire of Chapman Valley in relation to this project DECLARATION Name: * Position in Organisation: * Date * Type the code from the image: Do not fill this textbox.