Nambour Community Foundation Grant Application Form

Organisation and Contact Details

Name of Organisation

Email Address

First Name

Surname

Contact Number

Postal Address of Organisation

Provide a percentage breakdown of annual income between

Breakdown income and percentage

or add a income breakdown documentation

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Organisational Financial Details

Category / Finance Details

Eligibility Requirement

ABN Number

Please indicate which category your organisation falls under?

A not-for-profit community organisationA registered charity with the Australian Tax Office (ATO)Endorsed by the ATO as a deductible Gift RecipientEducational InstitutionOther

Please specify

Please indicate the region in which your service delivery is primarily focused

NambourNambour and surrounds (within 20 kms)Other

Please specify

Does your organisation have the appropriate insurances to support this project?

YesNoNot applicable

Project Details

Project Name

Describe your project, and what this grant will fund

Part funding

Indicative Project Budget

Budget

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Total Amount of grant requested $1000-$10000

Proposed Project start date

Proposed Project End Date

If your application is successful for a SCF grant, Sundale Community Foundation requests your agreement to acknowledge the funding from the Foundation in publications, social media, media, our website

Yes I agreeNo I don't agree

If you application is successful, the Sundale Community Foundation requests your agreement to be involved in publicity regarding the Foundations Grant Program, and you content to photos at our grants ceremony

Yes I agreeNo I don't agree

Authority

I (we) have read the grants guidelines and accept the requirements outlined in it and certify that the information submitted in this application is correct.

Authorised Person Name

Position in Organisation

Authorised Person Signature

Draw signature|Type signatureClear

Date signed