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Submission Received

DAWR Standard 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.
Your Submission Reference is:
Please quote your Submission Reference when enquiring about your submission.

For your records

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Form Saved

DAWR Standard 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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Enter your email address and we'll send you instructions on how to return to your form.

Check your email

We've sent instructions to your email address () on how to return to the application when you are ready. If you didn't receive it or would like a reminder send to a different email address, just click the link below and follow the instructions.

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 () website. Applications will be assessed using the process outlined in the Program Guidelines.

Application Help

Information about the Application process is available on the website. 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. In some areas of the form there are limits to the numbers of attachments being entered in a particular section. 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. If you wish to share this form and the access details, please ensure that only one user at a time is accessing and saving information. Ie. one person needs to be completed their updates and have saved and exited the form prior to another starting on their updates in 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 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 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 Program 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 Department uses an integrated Smartform service assisted by the Department of Industry, Innovation and Science on www.business.gov.au. If you are providing information to access a non-Department of Industry, Innovation and Science programme, that information 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 client agencies. The Community Grants Hub will be able to access the Application as part of the form support services. For more information about how the Department of Industry, Innovation and Science protects your privacy and personal information, please see the Department of Industry, Innovation and Science’s Privacy Policy External Site. The Community Hub Privacy Policy and WCaG Accessibility Information and the individual Department Privacy Policy should also be read and understood.

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.

Use of Information

may use the information, other than personal information, provided in this Application Form to assist to:

comply with the Australian Government requirement to publish the details of all grant recipients on the website, inform staff negotiating and establishing Grant Agreements of risks and issues that need to be addressed in the Grant Agreement for that programme, and/or inform future assessments for Applications.
You can only apply if you agree to using the information (not personal information) you provide in this form for the purposes listed above.
Check this box if you agree to the using the information (not personal information) you provide in this Application Form.

Existing Grant Recipient

Fields marked with * are required

Is the Applicant an existing Grant Recipient? *

You must respond to this question. Select 'No' if the Applicant is not an existing Grant Recipient. Select 'Yes' if the Applicant is an existing Grant Recipient. If yes is selected you then must enter your organisation ID number in the next field. The Applicant’s organisation ID number should be entered as it appears on the Grant Agreement. After entering the organisation ID, click on the 'Search' button to validate the ID to bring back key organisation details for this Application. Should there be any issues with validation, a message will be returned to give a choice on actions to progress. If you require assistance, please call .
If Yes, provide the Organisation Id number as it appears on your Grant Agreement and then click 'Verify number' to confirm the details are correct Tip: Copy and paste the Organisation Id number from the Grant Agreement to avoid errors.

Are updates required to the Applicant's details? *

You must respond to this question. Select ‘No’ if updates are not required to the Applicant’s details as currently held by the . Select ‘Yes’ if updates are required to the Applicant’s details as currently held by the . You will be required to contact your Grant Agreement Manager to update your details.

Updates to Applicant Details

Fields marked with * are required

Please contact your Grant Agreement Manager to update your details.

Mandatory check box if the response was 'Yes' to the question: "Are updates required to the Applicant’s details?" Check this box to confirm that you have contacted the and your organisation information is now current.

Applicant Details

Fields marked with * are required

Does the applicant have an Australian Business Number (ABN), Australian Company Number (ACN) or Australian Registered Body Number (ARBN)? *

You must respond to this question. For further details refer to http://www.abr.business.gov.au/.
If Yes, provide the Applicant's ABN and ABN Branch Number (if applicable)
Enter your ABN into the Australian Business Number (ABN) field and click the Validate ABN button to retrieve your registration details.
Enter the ABN Branch Number relevant to the Applicant’s ABN, if applicable. This is limited to 3 digits.
Enter your ACN into the Australian Company Number (ACN) field and click the Validate ACN button to retrieve your registration details.
If you have Trading/Business Names registered, you can select the relevant Business Name. If you have not registered your Business Name, you can either select "Same as Legal Entity" or "Other" in the "trading name/business name" field. If "Other" is selected, you will be asked to provide the Applicant's trading/business name in another field that will become available.
If No, provide a completed Statement by a supplier (reason for not quoting an ABN to an enterprise)
List of attachments (Note: Attach any relevant documentation. Mandatory to provide at least one document where it has been indicated that the Applicant is able to provide a completed Statement by a supplier.)

Attachment *

List of attachments (Note: Attach any relevant documentation. Mandatory to provide at least one document where it has been indicated that the Applicant is able to provide a completed Statement by a supplier. Only .doc .docx .pdf will be accepted)
File:

What is the Applicant's Legal Name? *

If your Application is successful, will only enter into a Grant Agreement with this legal entity. It may be different to the name the Applicant trades or provides services under.
You must respond to this question. 80 character limit. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.

Does the Application have a trading name (business name) different to their legal name? *

This is the trading/business name that the Applicant trades or provides services under. For further details about having a trading/business name refer to http://www.asic.gov.au. An example of an Applicant trading under a business name would be ABC Pty Ltd trading as Alpha Bravo Charlie Services.
You must respond to this question. Select 'No' if the Applicant does not have a trading name different to their legal name. Select 'Yes' if the Applicant trades under a name (eg. Business name), different to their legal name. If 'Yes' is selected, you must then enter the business/trading name in the 80 character limit field provided. NOTE: This field accepts the characters of A to Z, 0 to 9, ( ) . , ’ & -/ \ @, all other characters including carriage returns are not accepted.

What is the registered business address and main contact details of the Applicant?

The business address must be completed in full and 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

What is the postal address of the Applicant?

What is the postal address of the Applicant? The postal address must be completed in full. 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.

What is the Applicant's financial email address for the receipt of payment advice should the Application be successful?

You must respond to this question. 350 character limit. The email address must be entered in a valid format without spaces (eg. example@business.com.au). Payment advice includes Recipient Created tax invoices (RCTIs).

Is the Applicant GST registered? *

Is the Applicant GST registered? To be registered for GST the Applicant must have an active ABN. Questions on GST requirements should be addressed to the Australian Taxation Office. See www.business.gov.au for more information.

Does the Applicant operate as not-for-profit? *

For eligibility requirements, refer to the Program Guidelines Overview. For further details about not-for-profit organisations refer to the Australian Tax Office website.
You must respond to this question. Select ‘No’ if the Applicant operates for profit. Select ‘Yes’ if the Applicant operates as not-for-profit.

Is the Applicant registered as a charity by the Australian Charities and Not-for-profits Commission (ACNC)? *

For further details refer to http://www.acnc.gov.au/.
You must respond to this question. Select 'No' if the Applicant is not registered as a charity by the Australian Charities and Not-for profits Commission (ACNC). Select 'Yes' if the Applicant is registered as a charity by the Australian Charities and Not-for profits Commission (ACNC).

Eligibility Requirements

Fields marked with * are required

What is the Applicant's legal entity type? *

For a list of eligible legal entity types, refer to the Program Guidelines Overview. If you are unsure about the Applicant's legal entity type, please seek professional advice (e.g. from your lawyer or accountant) or refer to the Australian Business Register website for further information.
What is the Applicant's legal entity type? You must respond to this question. Choose the legal entity type that is relevant to the Applicant from the list. NOTE: Use the field’s scroll-bar or the keyboard’s down-arrow to view all available options. If you are unsure about the Applicant's legal entity type, please seek independent advice (e.g. from your Accountant) or refer to http://www.abr.business.gov.au/ for further information.

Is the Applicant able to provide documentation to support the legal entity type? *

You must respond to this question. At least one attachment must be provided if the response to "Does the Applicant have an Australian Business Number (ABN)?" was 'No'. Select 'No' if the Applicant is not able to provide documentation to support the legal entity type. Select 'Yes' if the Applicant is able to provide documentation to support the legal entity type. If 'Yes' is selected, click the 'Click to Upload' button to add the file in each attachment section and then click the 'Add Attachment' button to add sections for subsequent attachments. Note: the maximum size permitted per attachment file is 2mb and the overall form has the capacity to take 15MB of attachments in total. Once a file has been uploaded or an attachment section has been added, select the appropriate 'X' symbol button to delete.
If Yes, provide the documents required.
List of attachments (Note: Attach any relevant documentation. Mandatory to provide at least one document where it has been indicated that the Applicant is able to provide documentation to support their legal entity type.)

Attachment *

List of attachments (Note: Attach any relevant documentation. Mandatory to provide at least one document where it has been indicated that the Applicant is able to provide documentation to support their legal entity type. Only .doc .docx .pdf will be accepted)
File:

Question Detail
(Limit: approx characters)

Financial Viability and Governance

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

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)

Has any senior official or person directly involved in delivering the Activity (should the Application be successful) been involved in any litigation or prosecution that may reasonably be considered to be relevant to the Application? *

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 Activity? *

You must respond to this question. Select 'No' if there has not been any significant financial matter which may impact on the Applicant in the performance of the Activity. Select 'Yes' if there has been any significant financial matter which may impact on the Applicant in the performance of the Activity.
Note: you may be required to provide documentation upon request.

Are there any future commitments or contingent liabilities that might materially affect the Applicant in the performance of the Activity? *

You must respond to this question. Select 'No' if there are not any future commitments or contingent liabilities that might materially affect the Applicant in the performance of the Activity. Select 'Yes' if there are any future commitments or contingent liabilities that might materially affect the Applicant in the performance of the Activity.
Note: you may be required to provide documentation upon request.

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)

Does the Applicant have 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)

Activity Details

Fields marked with * are required

Provide a short title of your Application for this 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.

Provide a brief description of your Application for this 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)

In which coverage area/s is the Applicant proposing to deliver the Activity?

IMPORTANT: If applicable and your form has more than coverage areas available for selection, note that Applicants can only select up to coverage areas per Application form due to the large amount of data required for a detailed response. If you wish to apply for more than coverage areas, a separate form/s will need to be completed. If you wish to reuse data from your first form submission for this purpose, upon submission of your first form immediately open a new copied form off the submission page using the 'Start and new form prefilled with the same data’ link. This will open the same form data with only the coverage area and attachment information removed. You must open and save this form immediately as the previously submitted data will not be captured in any new form if not done this way. If the ‘Start and new form prefilled with the same data’ option is not done at the time of the initial form submission then a new Application form will need to be completed for all information, as well as the extra coverage areas.
Instructions:

The Coverage type field below indicates the areas used in this Application form.If applicable, select a State to refine the available coverage area values. A list of values will appear in the Available coverage area/s for selection. Choose the appropriate value/s and click Add to insert the highlighted value/s into the Chosen coverage area/s. Repeat the process as required.
Tips:

Enter text in the 'Search list...' to search for the specific area or to reduce the list of available areas.To choose multiple values to add at one time, use Shift+Left-Click to select a group of values, or useCtrl+Left-Click to select a range of alternating values, and then click Add.To delete from the 'Chosen coverage area/s', choose the value in the right list box and click the Delete button.For further details of the available coverage area/s refer to the website
You have reached the maximum number of coverage areas able to be selected in this form and per instruction text in this question. If you wish to change your selection, remove areas not required and enter the new ones. NOTE: if you selected more than the allowed limit to move to the list of chosen coverage areas, please review the areas that have made it to the selection prior to continuing and adjust if required.
Coverage Areas

For this Activity will workers be employed under either of the listed awards? *

You must respond to this question. IMPORTANT NOTE: The SACS questions to be responded to are determined by the State of the Applicant legal entity address. Applicants where the home state of their legal entity is Western Australia would see the question: "For this Activity will workers be employed under either of the listed awards?" Applicants where the home state of their legal entity is Queensland would see the question: "For this Activity will workers be employed under the Social, Community, Home Care and Disability Services Industry Award 2010 (SACS Modern Award)?"
SPECIFICALLY
- Schedule B - Social and Community Services Employees
- Schedule C - Crisis Accommodation Employees’
Applicants where the home state of their legal entity is Tasmania, New South Wales, Victoria, Northern Territory, Australian Capital Territory, or South Australia would see the question: ‘For this Activity will workers be employed under the Social, Community, Home Care and Disability Services Industry Award 2010 (SACS Modern Award)?
SPECIFICALLY
- Schedule B - Social and Community Services Employees
- Schedule C - Crisis Accommodation Employees

For this activity will workers be employed under the Social, Community, Home Care and Disability Services Industry Award 2010 (SACS Modern Award) specifically? *

You must respond to this question. Select ‘No’ if for this activity workers will NOT be employed under the Social, Community, Home Care and Disability Services Industry Award 2010 (SACS Modern Award) specifically. Select ‘Yes’ for this activity workers will be employed under the Social, Community, Home Care and Disability Services Industry Award 2010 (SACS Modern Award) specifically.

Has your organisation previously employed workers under the Queensland Community Services and Crisis Assistance Award - STATE 2008? *

You must respond to this question. Select ‘No’ if your organisation has not previously employed workers under the Queensland Community Services and Crisis Assistance Award – State 2008. Select ‘Yes’ if your organisation has previously employed workers under the Queensland Community Services and Crisis Assistance Award – State 2008.

Does the Applicant plan to deliver the Activity as part of, or as the lead agency of, a consortium or use subcontractors? *

Does the Applicant plan to deliver services as part of, or as the lead agency, of a consortium or use subcontractors? An Applicant may determine that service delivery is best achieved through the use of a consortium arrangement or use subcontractors. If yes, you will be required to provide the details of each consortium member/subcontractor details. Up to 10 consortium members/subcontractors can be included in the Application Form by clicking the add button at the end of this question.
If Yes, provide the Consortium/Subcontractors 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.

Area Financials

Fields marked with * are required

Provide a breakdown of the proposed grant funding by the chosen coverage type/s. *

Provide a breakdown of the proposed grant funding by the chosen coverage type/s. You must complete a separate row for each chosen coverage area.
Please note that you must complete the “In which coverage types is the Applicant proposing to deliver the Activity?” question before you can commence this question.
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 Activity rely on any contributions other than those requested in this Application (including commercial borrowings, donations and co-contributions)? *

Does the Activity rely on any contributions other than those requested in this Application? Include any other Applications for funding that you have submitted in relation to this Activity and indicate that these are pending the outcome of an Application. Mandatory. 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 contributions which will be relied upon to complete this Activity.

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 of funding
(List a maximum of 10)
Amount of funding (exc GST)
Status of Application

Provide bank account details for receipt of grant payments should the 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.

Selection Criteria

Fields marked with * are required

Question Detail
(Limit: approx characters)

Attachments

Fields marked with * are required

Question Detail
List of attachments.
File:

Question Detail
List of attachments.
File:

Question Detail
List of attachments.
File:

Applicant Contacts

Fields marked with * are required

Who is the Applicant's preferred authorised contact person for this Application?

Who is the Applicant's preferred 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 authorised contact for this Application. *

Provide an alternate authorised contact for this Application. Mandatory. 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

Declaration

Fields marked with * are required

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 Program Guidelines overview.I have read, understood and agree to the Grant Terms and Conditions, should this Application be successful.I agree to receiving a Recipient Created Tax Invoice (RCTI) for this funding if this Application is successful.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.I give consent to the to make public the details of the Applicant and the funding received, should this Application be successful.
(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 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