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Submission Received

Community Child Care Fund Application Form
This form has been submitted for consideration for the above Application process. Based on system generated information it appears that this Application has been submitted on time. Please note that the submission of this Application does not equate to automatic acceptance of the Application. The Application acceptance notification and information will be provided separately via email to the main email contact provided on this Application. Contact via Phone on or via email for any questions regarding this Application.
This form has been submitted for consideration for the above Application process. Based on system generated information it appears that this Application has not been submitted on time. The Application is therefore unlikely to be accepted. Note that the submission of this Application does not equate to automatic acceptance of the Application. The Application acceptance notification and information will be provided separately via email to the main email contact provided on this Application. Contact via Phone on or via email for any questions regarding this Application.

Next steps

You are required to complete these additional forms to finalize your request.
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Form Saved

Community Child Care Fund Application Form
Your form has been saved and may be re-opened later.
Your Submission Reference is:
Please note that your saved form, if not updated or submitted within a set period of time, will be deleted.Please ‘Send yourself a reminder email’ below. This email details the date and time your form will be deleted, the Submission Reference number, a link to access your saved form and information on how to contact us for further assistance.

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Application Information

Fields marked with * are required

Closing Date/Time

Applications must be submitted by Canberra local time on .
Closing Time: System generated information indicates that this Application process has closed. Contact via phone on or via email for any questions regarding this Application process.
Closing Time: System generated information indicates that this Application process has closed. Please check the latest details at to ensure the Application process is still open prior to trying to submit the form. Note that while your form may still be able to be submitted, it may not be considered in the Application assessment process. Contact via phone on or via email for any questions regarding this Application process.
This application, if submitted, will be considered as a late application and as such the Department reserves the right not to consider this application. If you wish to continue this application through to the submission stage and believe you have exceptional circumstances then you must provide details in the text box below as to why this application has been submitted after the published close date. Examples of exceptional circumstances could include, but may not be limited to: Community Grants Hub infrastructure failures, natural disasters, power outages affecting the ability of applicants to submit their application by the stipulated deadline, or death or disability of key personal. Any other proposed incidents of exceptional circumstances, other than those listed above, will be consider by the Community Grants Hub on a case-by-case basis.
(Limit: approx 300 words, 2,000 characters)

If you have any supporting document on your extenuating circumstances then you may attach here. Please note that this is not mandatory and is limited to one attachment only.

List of attachments (Note: Attach any relevant documentation. Mandatory to provide one document.)
File:

Making Sure Your Application is Saved

The ‘Continue’ button will not save your Application. For your Application to be saved, you will need to click on: ‘Save and Exit’, and ‘Confirm’. You will know that your application is saved when you are taken from the current form process to the ‘Form Saved’ page. Note that the ‘Save and Exit’ button will ask that you ‘Confirm’ that you wish to save the Application, which you must do to complete the save process. If this is not done, your Application will not be saved. You can return to your Application with the data saved using the link on the 'Form Saved' page that says 'Click here to return to your form' and confirming your submission reference ID details.

Application Pack

Read all information in the Application Pack before completing this Application Form. The Application Pack is available on the Community Grants Hub website. Applications will be assessed using the process outlined in the Community Child Care Fund – open competitive process (for approved child care services) Grant Guidelines.

Community Grants Hub

This round is being administered by the Community Grants Hub on behalf of the Department of Education and Training.

Application Help

Information about the Application process is available on the Community Grants Hub and GrantConnect websites. Applicants must submit any questions relating to the Program or this Application process in writing to . Applicants may submit these questions up until five Business Days prior to the Closing Time and Date. A response will be provided within five business days. Applicants may direct any general enquiries, requests for technical help or support in using and/or submitting the Application Form by: Phone Email to

Attachment Limits

This Application Form has been set up to allow users to attach files within the form. The maximum size allowable for individual attachments is no larger than 2MB and the form will not accept individual attachments above this size. Please read individual question instructions carefully to be informed of these limits. The total size of all of the attachments combined in the form will not be allowed to exceed 15MB. Please plan to modify your attachment files accordingly if necessary.

Sharing this Form

Please note that more than one person should not be accessing this form at the same time. If this is done then there is a risk that information may be lost in the form and all information will not be transferred in submission. To avoid any issues with your submission, ensure each contributor has completed their updates, saved their changes and exited the form prior to another person accessing the same form.

Submission Reference ID

Each Application Form is allocated a unique Submission Reference ID. Each time this Application is accessed you will be required to use this Submission Reference ID.

Submitting Application Form

Once you have completed this Application Form, you must submit it electronically by using the submission section at the end of this form. Please note: there may be short, scheduled outages to systems as part of regular information technology maintenance that may affect submission of this form. Notification of these outages will be on the Community Grants Hub website. Following electronic submission, a message with your Submission Reference ID will appear on your screen. An email will be sent to the main email contact and the provider organisation (if applicable) provided in the Application Form. A function is also available on the submission page to allow you to send a receipt email to the address of your choosing. Please save this email receipt for future reference and use it in all correspondence about this Application. Note: Applications will be assessed using the process outlined in the Application Pack and Grant Guidelines. The Department will notify all Applicants of the grant funding outcome on completion of the assessment process.

National Relay Service (NRS)

uses the NRS to ensure our contact numbers are accessible to people who are deaf or have a hearing or speech impairment. Please phone to access the NRS.

Privacy

The information you provide on this application form will be collected and used by the Department of Social Services (who implemented the Community Grants Hub), and disclosed to and used by the Department of Education and Training, for the purpose of assessing your application and ongoing administration and evaluation of the program. Please refer to the Privacy Policy and Web Accessibility Policy of the Department of Social Services, and the Privacy Policy of the Department of Education and Training.The Community Grants Hub uses an integrated Smartform service assisted by the Department of Industry, Innovation and Science on www.business.gov.au.The information in your Application will not be accessed by Department of Industry, Innovation and Science employees. The only exception to this is where Senior Analysts within the Department of Industry, Innovation and Science require access to your information for the sole purpose of troubleshooting technical errors. Where this occurs Senior Analysts will only access the data with permission and at the request of Community Grants Hub.For more information about how the Department of Industry, Innovation and Science protects your privacy and personal information, please see the www.business.gov.au. and Department of Industry, Innovation and Science’s Privacy Policy External Site.

Use of Information

Fields marked with * are required
Your Submission Reference is:


Please note that your saved form, if not updated or submitted within a set period of time, will be deleted.Please ‘Send yourself a reminder email’ below. This email details the date and time your form will be deleted, the Submission Reference number, a link to access your saved form and information on how to contact us for further assistance.

Pre-population

Your organisation name is collected and stored in the departmental system by the for the purpose of administering Child Care Benefit approval under the Family Assistance Law. The Community Grants Hub and will use the Organisation ID number that you enter into the form to populate the corresponding organisation name details that have been recorded for your organisation in the departmental system. The purpose of this is to: reduce the administrative burden on applicants and enable applicants to more quickly complete applications ensure applicants can be notified as soon as possible of assessment outcomes ensure consistency of information in the system. The pre-populated information about applicants is held securely. Any information obtained under the Family Assistance Law as part of the pre-population will continue to be protected by law, including the Privacy Act 1988 and the Family Assistance Law. If the pre-populated information is not correct or if you do not agree to your organisation name being pre-populated in the form please contact the Community Grants Hub by: Phone Email to Please note that even if you do not agree to your application form to be pre-populated, your organisation ID will still be linked to the corresponding organisation name, which is stored in the system. Only the organisation name may become available to applicants who choose to pre-populate by entering that specific organisation ID.
Check this box if you agree to the using the information (not personal information) you provide in this Application Form.

Use of Information

The Community Grants Hub and Department of Education and Training may use the information, other than personal information, provided in this Application Form to assist the Community Grants Hub and the Department of Education and Training to: 1.comply with the Australian Government requirement to publish the details of all grant recipients on the Community Grants Hub and the Department of Education and Training website 2.inform staff negotiating and establishing Grant Agreements of risks and issues that need to be addressed in the Grant Agreement for that program 3.inform future assessments for Applications.
You can only apply if you agree to the Community Grants Hub and the Department of Education and Training using the information (not personal information) you provide in this form for the purposes listed at 1), 2) and 3) above. In addition, the Community Grants Hub may use the applicant’s personal information, or disclose it to another organisation or government agency, if: it is necessary to provide the applicant with a service requested (including enabling the Community Grants Hub and the Department of Education and Training to progress/assess your application, and notifying the applicant’s updated details). the applicant consents to the particular use or disclosure; the use or disclosure is reasonably necessary to lessen or prevent a threat to the life, health or safety of an individual, or to public health or safety or where the use or disclosure is reasonably necessary in order for the department or another government agency to take appropriate action in relation to suspected unlawful activity or misconduct; or the use or disclosure is required or authorised by law.
Check the box below if you agree to the using the information (not personal information) you provide in this Application Form.

Eligibility Requirements

Community Child Care Fund Application Form
Fields marked with * are required

For eligibility requirements, refer to the Community Child Care Fund – open competitive process (for approved child care services) Grant Guidelines.

For eligibility requirements, refer to the Community Child Care Fund – open competitive process (for approved child care services) Grant Guidelines.

Are you a not-for-profit organisation? *

Please refer to the Grant Guidelines for more information on not-for-profit organisations.
You have selected ‘No’ as a response to the question: “are you a not-for-profit organisation?” If an Applicant is a for-profit organisation they are deemed ineligible to apply for the Community Child Care Fund and you will be unable to proceed with this Application.

Is the approved child care service where this proposed activity will be delivered currently in receipt of Community Support Program funding? *

Is the approved child care service where this proposed activity will be delivered operating in a priority area? *

The priority list, is based on Australian Early Development Census (AEDC), Socio-Economic Indexes for Areas (SEIFA), remoteness and population data. Applicants can check whether their area is on the priority list here.
You have selected ‘No’ as a response to the question: “Is the approved child care service where this proposed activity will be delivered operating in a priority area?”. If an Applicant’s service is not operating in a priority area they are deemed ineligible to apply for the Community Child Care Fund and you will be unable to proceed with this Application.

Grant Recipient Details

Fields marked with * are required

Are you applying on behalf of an approved provider of an approved child care service? *

To be eligible to apply under the CCCF – open competitive process, you must be the approved provider (the applicant) of an approved child care service under the family assistance law. If approved, the CCCF grant agreement will be between the Commonwealth and the approved provider. Applications for funding will also be accepted from approved child care services where they have been authorised to submit on behalf of the approved provider.
You have indicated that you are not applying on behalf of an approved provider of an approved child care service. Only approved providers of an approved child care service are eligible to apply for the Community Child Care Fund and you will be unable to proceed with this Application.
This information must relate to the approved provider of an approved child care service. If you require assistance with locating your Organisation ID, please contact the Community Grants Hub hotline on

Please provide the details of the approved child care service where the proposed activity will be delivered.

Approved providers can apply for funding with respect to the approved child care service that they operate and where the proposed activity will be delivered
This information must relate to the approved child care service. If you require assistance with locating your Organisation ID, please contact the Community Grants Hub hotline on

What is the service type of the approved child care service where this proposed activity will be delivered? *

Please provide the Child Care Benefit Approval (CCB) information that relates to the approved child care service where the proposed activity will be delivered. *

Please provide the Child Care Benefit Approval (CCB) information that relates to the approved child care service where the proposed activity will be delivered. *

Does the applicant plan to deliver the proposed activity as part of, or as the lead agency of a consortium? *

Some organisations may apply together, as a consortium, to deliver grant activities. If you are submitting a joint grant application or submitting on behalf of a consortium, a member organisation or a newly created organisation must be appointed as the ‘lead organisation’. The lead organisation must be an approved provider under the family assistance law. Only the lead organisation will enter into a grant agreement with the Commonwealth and will be responsible for the grant. The lead organisation must complete the application form and identify all other members of the proposed consortium in the application. The lead organisation will act on behalf of all members of the consortium, and enter into contracts which are binding to them.
If Yes, provide the Consortium details.

Details

You have reached the maximum number of records allowed. Use the Attachments question to add further records if required.
An Applicant may determine that service delivery is best achieved through the use of a consortium arrangement.

If the Application is successful, the Applicant will be offered a Grant Agreement with as the lead agency and held liable for all obligations contained in the Grant Agreement's Terms and Conditions. This includes monitoring, management, financial performance, service outcomes and insurance coverage.

The panel of consortium members does not enter into a Grant Agreement with . The Applicant should obtain agreement prior to submitting this Application.

Further evidence of the consortium arrangements may be sought from successful Applicants prior to the signing of the Grant Agreement.

Applicant Contacts

Fields marked with * are required

Who is the legally authorised contact person for this Application?

Who is the legally authorised contact person for this Application? The person must have authority to act on behalf of the Applicant in relation to this Application.

Provide an alternate legally authorised contact for this Application. *

Provide an alternate legally authorised contact for this Application. This person must also have authority to act on behalf of the Applicant in relation to this Application.

Applicant Referees

Fields marked with * are required

Provide the name and contact details of two referees who can support the Applicant's claims made against the selection criteria as outlined in this Application.

Please do not use the Applicant's Board members or the Applicant's staff and please exclude employees of as referees.
Referee One
Referee Two

Financial Viability and Governance

Fields marked with * are required
Do any of the following legal situations apply to the Applicant?

Has any Australian Government agency notified the applicant of any issues with compliance with child care laws and regulations? *

You must respond to this question. Select 'No' if the Applicant has not been notified of any issues with compliance with child care laws and regulations by any Australian Government agency Select 'Yes' if the Applicant has been notified of any issues with compliance with child care laws and regulations by any Australian Government agency. If Yes, provide details and/or an explanation of why any issues with compliance with child care laws and regulations should not be considered relevant to the application. in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. If the Applicant has settled a claim on confidential terms, please indicate this in your response. may request further information as part of the assessment process. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 300 words, 2,000 characters)

Has any Australian Government agency notified the child care service related to this application of any issues with compliance with child care laws and regulations? *

You must respond to this question. Select 'No' if the Applicant has not been notified of any issues with compliance with child care laws and regulations by any Australian Government agency Select 'Yes' if the Applicant has been notified of any issues with compliance with child care laws and regulations by any Australian Government agency. If Yes, provide details and/or an explanation of why any issues with compliance with child care laws and regulations should not be considered relevant to the application. in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. If the Applicant has settled a claim on confidential terms, please indicate this in your response. may request further information as part of the assessment process. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 300 words, 2,000 characters)

Has the Applicant been involved in any litigation or prosecution in the past three years? *

You must respond to this question. Select 'No' if the Applicant has not been involved in any litigation or prosecution in the past three years. Select 'Yes' if the Applicant has been involved in any litigation or prosecution in the last three years. If 'Yes' is selected, you must then provide details and/or explanation of why the litigation or prosecution should not be considered relevant to the Application in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. If the Applicant has settled a claim on confidential terms, please indicate this in your response. may request further information as part of the assessment process. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 300 words, 2,000 characters)

Have any key personnel directly involved in delivering the proposed activity (should the Application be successful) been involved in any litigation or prosecution? *

You must respond to this question. Select 'No' if no senior official or person directly involved in delivering the Activity (should the Application be successful) has been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application. Select 'Yes' if any senior official or person directly involved in delivering the Activity (should the Application be successful) has been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application. If 'Yes' is selected, you must then provide the details of any senior official or person directly involved in delivering the Activity and details of the litigation or prosecution in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. If the Applicant has settled a claim on confidential terms, please indicate this in your response. may request further information as part of the assessment process. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 300 words, 2,000 characters)

Has there been any significant financial matter which may impact on the applicant in the performance of the proposed activity? *

You must respond to this question. Select 'No' if no senior official or person directly involved in delivering the Activity (should the Application be successful) has been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application. Select 'Yes' if any senior official or person directly involved in delivering the Activity (should the Application be successful) has been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application. If 'Yes' is selected, you must then provide the details of any senior official or person directly involved in delivering the Activity and details of the litigation or prosecution in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. If the Applicant has settled a claim on confidential terms, please indicate this in your response. may request further information as part of the assessment process. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 300 words, 2,000 characters)

Are there any future commitments or contingent liabilities that might materially affect the applicant in the performance of the proposed activity? *

You must respond to this question. Select 'No' if no senior official or person directly involved in delivering the Activity (should the Application be successful) has been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application. Select 'Yes' if any senior official or person directly involved in delivering the Activity (should the Application be successful) has been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application. If 'Yes' is selected, you must then provide the details of any senior official or person directly involved in delivering the Activity and details of the litigation or prosecution in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. If the Applicant has settled a claim on confidential terms, please indicate this in your response. may request further information as part of the assessment process. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 300 words, 2,000 characters)

If requested, is the applicant able to provide the following financial information?

A 'Yes' or 'No' response to all sub questions on whether the Applicant is able to provide the following financial information is Mandatory. Two most recent sets of year-end audited financial statements. Current year-to-date management financial information, for example, income and expenditure statement and balance sheet. The Applicant's financial statements fully compliant with the Australian Accounting Standards. If 'No' is selected for any of these sub questions, you must then provide a brief explanation for the 'No' response in the 2000 character limit (approximately 300 words) field provided. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
Note: you may be required to provide documentation upon request.
1. Two most recent sets of year-end financial statements.
2. Current year-to-date management financial information, for example, income and expenditure statement and balance sheet.
3. Are the Applicant's financial statements fully compliant with the Australian Accounting Standards?
(Limit: approx 300 words, 2,000 characters)

If requested, is the applicant able to provide the following documents?

Note: you may be required to provide documentation upon request.
A 'Yes' or 'No' response to all sub questions on whether the Applicant is able to provide the following documents is Mandatory. Documented organisational and financial policies and procedures. Business plan and/or strategic plan. Risk management plan. Note: You may be required to provide copies of the above documentation within 7 days upon request.
1. Documented organisational & financial policies & procedures.
2. Business plan and/or strategic plan.
3. Risk management plan.

Question Detail
(Limit: approx characters)

About the Proposal

Community Child Care Fund Application Form
Fields marked with * are required

What element of the CCCF will you be applying for? *

If you are applying for more than one element, the option of pre-filling your form with the information you have provided up to this point is available. Alternatively, you can choose to commence a new application form for each element. These options will be presented to you upon submission of this form.
What element of the CCCF will you be applying for?

Are you operating in an area of limited supply? *

Please refer to the Grant Guidelines for more information about operating in an area of limited supply.
You have indicated that you are not operating in an area of limited supply. Only approved providers of an approved child care service operating in an area of limited supply are eligible to apply for the Sustainability Support element of the Community Child Care Fund, and you will be unable to proceed with this Application.You may be able to apply for another element by selecting a different element option above.

Are you operating in an area of high unmet demand? *

Please refer to the Grant Guidelines for more information about operating in an area of high unmet demand.
You have indicated that you are not operating in an area of high unmet demand. Only approved providers of an approved child care service operating in an area of high unmet demand are eligible to apply for the Capital Support element of the Community Child Care Fund, and you will be unable to proceed with this Application. You may be able to apply for another element by selecting a different element option above.

Activity Details

Fields marked with * are required

Please provide a short title of your application for the proposed activity. *

You must respond to this question. 250 character limit. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.

Please provide a brief description of your application for the proposed activity. *

You must respond to this question. 1000 character limit (approximately 150 words). The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.
(Limit: approx 150 words, 1,000 characters)

Please provide the actual physical address where the proposed activity will be delivered.

The physical address where the proposed activity will be delivered must be completed in full and must not be a PO Box. For example: Level 1 Main Building 220 Business Street Canberra City ACT 2601 Note: the address fields accept the characters of A to Z, 0 to 9, ( ) . , ' & - / \ @, all other characters including carriage returns are not accepted. Please note that if an Applicant selects 'Unable to validate' following an initial failed validation attempt, the Department will use this non-validated address for correspondence.
Address Validated
Address NOT Validated

Will the proposed activity create additional child care places? *

Please specify the number of proposed additional child care places *
Note: The number of child care places a service can provide is dependent upon approval by the relevant State/Territory Regulatory Authority.

How many additional child care places will the proposed activity create?

Proposed activities under the Capital Support element must result in more child care places. *
Note: The number of child care places a service can provide is dependent upon approval by the relevant State/Territory Regulatory Authority.

Will the proposed activity target children living in rural and/or regional communities? *

Which category best describes the target audience for the proposed activity? *

Funding for the Proposal

Fields marked with * are required

Please provide a breakdown of the proposed funding for the proposed activity. *

Provide a breakdown of the proposed funding by financial year
Amount($ exc GST)
Amount($ exc GST)
Amount($ exc GST)
Amount($ exc GST)
Amount($ exc GST)
Total funding
Approx.% of Total
Financial year
Total funding

Does the proposed activity rely on any contributions other than those requested in this application (including commercial borrowings, donations and in-kind or other co-contributions. *

If Yes, provide details of other grant applications or approvals that the applicant is responsible for. Please note that you may be requested to provide letters of support or other forms of evidence before your application is considered further in the assessment process. If Yes, you will be required to provide the details of the other funding submissions. Up to 10 records can be included in the Application Form by clicking the add button at the end of this question.
If Yes, provide details of other grant applications or approvals that the applicant is responsible for.

Please note that you may be requested to provide letters of support or other forms of evidence before your Application is considered further in the assessment process.
Source/Type of co-contribution (list a maximum of 10)
Amount/Value of co-contribution($ excl GST)
Status of co-contribution
Percentage of co-contribution out of total funding requested
(Limit: approx 300 words, 2,000 characters)

Is the applicant in the process of applying for, or has the applicant recently been approved for (in the last 12 months), other grant funding outside of the Department of Education and Training for the proposed activity? *

If Yes, provide details of other grant applications or approvals that the applicant is responsible for. Please note that you may be requested to provide letters of support or other forms of evidence before your application is considered further in the assessment process. If Yes, you will be required to provide the details of the other funding submissions. Up to 10 records can be included in the Application Form by clicking the add button at the end of this question.
If Yes, provide details of other grant applications or approvals that the applicant is responsible for.

Please note that you may be requested to provide letters of support or other forms of evidence before your Application is considered further in the assessment process.
Name of other Grant Program
(List a maximum of 10)
Amount of funding (exc GST)
Status of Application

Please provide the bank account details of the applicant for the receipt of Community Child Care Fund grant payments should this application be successful.

You must respond to this question. Bank account details for the receipt of payments: BSB Number: Enter the BSB number for the Applicant’s nominated bank account. Must be 6 digits only. Do not enter spaces or other characters. Account Number: Enter the account number for the Applicant’s nominated bank account. Must be 2 to 9 digits only. Do not enter spaces or other characters. Account Name: Enter the account name for the Applicant’s nominated bank account. The account name should be as it appears on the bank statement. 60 character limit. The character count includes letters, numbers, spaces, paragraph marks, bullet points etc. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.

Assessment Criteria

Fields marked with * are required

Criteria

Question Detail
(Limit: approx characters)

Attachments

Fields marked with * are required

All attachments must be submitted with the Application Form as separate documents.

Upload your budget proposal
File:
The mandatory budget proposal template to be used is available on the GrantConnect and Community Grants Hub websites.

All attachments must be submitted with the Application Form as separate documents.

Upload your budget proposal
File:
The mandatory budget proposal template to be used is available on the GrantConnect and Community Grants Hub websites.

All attachments must be submitted with the Application Form as separate documents.

Upload your budget proposal
File:
The mandatory budget proposal template to be used is available on the GrantConnect and Community Grants Hub websites.
Upload your evidence of land/building ownership or permission from the land/building owner to implement proposal
File:
Upload your simple floor plan
File:

Declaration

Fields marked with * are required

Privacy consent

As the legally authorised representative of the applicant: I give consent to the Department of Education and Training to disclose any information that it holds about the applicant: that has been obtained under the family assistance law, or obtained in the course of administering a Commonwealth grant
to the Department of Social Services (who operates the Community Grants Hub), and third parties contracted to the Department of Education and Training and/or the Community Grants Hub, for the purpose of assessing my application, administration or evaluation of the program, and for the purposes as outlined under ‘privacy’ and ‘use of information’ sections of this application form. Where the Department of Education and Training discloses information about the applicant to the Department of Social Services, or to third parties contracted to the Department of Education and Training and/or the Community Grants Hub, for the purposes of assessing my application, administration or evaluation of the program, and for the purposes as outlined under ‘privacy’ and ‘use of information’ sections of this application form, I also give consent to the Department of Social Services or third party to collect and use such information for the same purpose. I consent to the Department of Education and Training and the Community Grants Hub to disclose the applicant’s organisation name to the corresponding organisation ID as part of this application form’s pre-population function. I give consent to the Department of Education and Training to make public the details of the applicant and the funding received, should this application be successful.

Please read and complete the following declaration.

This Declaration must be signed by an authorised representative of the Applicant (or, if this Application is a joint/consortium Application, an authorised representative of the lead organisation). The authorised representative should be a person who is legally empowered to enter into contracts and commitments on behalf of the Applicant.
I declare that:

The information contained in this form is true and correct I have read, understood and agree to abide by the Grant Guidelines I have the authority to submit this application on behalf of the applicant. The applicant is aware that they will enter into a funding agreement with the , should this application be successful I have read, understood and agree to the Grant Terms and Conditions, should this application be successful I will retain receipts/evidence which document the appropriate expenditure of funding, should this application be successful I agree not to misuse any information that is made available to me which was obtained for the purpose of completing this application If my application is successful, I will contact the relevant State/Territory Regulatory Authority to notify all changes that may impact my approval under national law and I will contact the Department of Education and Training to notify all changes that may impact my approval under the family assistance law. I understand that incomplete applications may not be considered I agree to receiving a Recipient Created Tax Invoice (RCTI) for this funding if this application is successful, and If and where any personal details of a third party are included, the third party has been made aware of, and given their permission for those details to appear in this application.
Do you have any conflicts of interest that may occur related to or from submitting this application?
(Limit: approx 300 words, 2,000 characters)
Please provide an estimate of the time taken to complete this Application Form, including:

actual time spent reading the Grant Guidelines, instructions and questions; time spent by all employees in collecting and providing the information and;time spent completing all questions in the Application Form.
Please provide an estimate of the time taken to complete this Application Form, including: actual time spent reading the guidelines, instructions and questions, time spent by all employees in collecting and providing the information, and time spent completing all questions in the Application Form.

Submission Parameters

Application

Legal Entity

Service Provider

Payee

Department Use Only

Funding Round Details - the following information is pre-populated from the FOFMS funding round: