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You are here Home Community support Grants and funding Community Grants Community improvement application

Community improvement application

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Community improvement application
Grant Acquittal Form

Please note that you CANNOT save and continue this form, so ensure that you have all required documentation BEFORE you start. Please read the CHRC Community Grants Program Guidelines prior to completing this form.
Please acknowledge you have read the eligibility guidelines before completing this form*
- Yes
- No
Section A: Organisation Details
Name of your organisation*
Address*
Street Address Suburb State Post code
Postal address*
Postal Address Suburb State Post code
Phone*
Email*
Number of active members
Total number of active members
Please provide information about the contact person for this application.
Name of contact person*
First Last
Position*
Phone number of contact person*
Email of contact person*
Is your organisation Incorporated*
- Yes
- No, you will need a sponsoring body that is incorporated to proceed with this application
Incorporation number
Please provide information about your organisation.
Is your Organisation Registered for GST*
- Yes
- No
Does your organisation have an ABN number*
- Yes
- No
If yes, please provide your organisations ABN
Does your organisation have public liability insurance to cover this program, project and/or activity*
- Yes
- No (ineligible)
Please upload a copy of your organisation's public liability insurance*
Max. file size: 256 MB.
Is your organisation required to undertake an annual financial audit as per the rules of incorporation?*
- Yes (please attach full copy of the latest audited statement)
- No (please attach a copy of your organisation's latest financial or treasurer's report covering previous 12 months)
Please upload a full copy of the latest audited statement
Max. file size: 256 MB.
Please upload a copy of your organisation's latest financial or treasurer's reporting covering the previous 12 months.
Max. file size: 256 MB.
Please provide information about your incorporated sponsor.
Organisation
Address*
Street Address Suburb State Postcode
Postal Address
Postal Address Suburb State Postcode
Phone
Email
Incorporation Number
Is your organisation registered for GST
- Yes
- No
Does your organisation have an ABN number*
- Yes
- No
If yes, please provide your organisations ABN
Does your organisation have public liability insurance to cover this program, project and/or activity*
- Yes (attach a copy)
- No (ineligible)
Please upload a copy of your organisation's public liability insurance.
Max. file size: 256 MB.
Is your organisation required to undertake an annual financial audit as per the rules of incorporation?*
- Yes (please attach full copy of the latest audited statement)
- No (please attach a copy of your organisation's latest financial or treasurer's report covering previous 12 months)
Please upload a full copy of the latest audited statement.
Max. file size: 256 MB.
Please upload a copy of your organisation's latest financial or treasurer's reporting covering the previous 12 months.
Max. file size: 256 MB.
Sponsor declaration*
- By ticking this box, I confirm that I have written authorisation from my sponsor.
Section B: Grant Details
Which funding round are you applying for?*
This application form is for ‘Community Improvement Grants’ Category, have you read the guidelines to ensure you are applying under the correct category?
- Yes
- No
Have you spoken with a Community Grants Officer in relation to this application?
- Yes
- No
Title of the program, project and/or activity requiring funding*
Description of the program, project and/or activity for which you are seeking funding.
Amount requested*
Have you previously been a successful applicant for a CHRC grant?*
- Yes
- No
Were you successful in the previous grant round?*
- Yes (ineligible)
- No
Have you acquitted all previous CHRC grants?*
- Yes
- No
Please explain why you have not acquitted previous grants.
Main location of activities for this program, project and/or activity
- Central Highlands region
- Arcadia Valley
- Bauhinia
- Blackwater
- Bluff
- Capella
- Comet
- Dingo (Karramara)
- Duaringa
- Emerald (Gindie, Fernlees)
- Gemﬁelds (Anakie, Rubyvale, Sapphire, Willows Gemﬁelds)
- Lochington (Orion Tresswell)
- Rolleston (Toprain)
- Springsure (Buckland)
- Tieri
Anticipated start date and duration of program, project and/or activity
How will your organisation fund recurrent expenses in future years (if applicable)?
Is this a new program, project and/or activity?
- Yes
- No
If yes, please provide additional details
How will it assist in the increase of participation in the club? (e.g members, volunteers, spectators)
How will your organisation acknowledge CHRC's contribution/assistance towards your program, project and/or activity?
Section C: Considerations
Does your club have any outstanding debts with CHRC?*
- Yes (ineligble)
- No
Has your organisation received a contribution from CHRC’s Capital investment plan
- Yes
- No
If yes, please provide details
Are you on Council owned or controlled land?
- Yes
- No
If yes, please attach a letter of approval*
Max. file size: 256 MB.
Do you have a lease or user agreement with Central Highlands Regional Council?
- Yes
- No
If yes, please attach copy of agreement*
Max. file size: 256 MB.
Did you consult with any other organisations including council in regard to your application?
- Yes
- No
If yes, please attach evidence/letter of support*
Max. file size: 256 MB.
Section D: Selection Criteria
NOTE: The following questions form the main part of the selection criteria. The weighting is noted in percentage next to the question.
What is the main reason you are applying for this funding and how does it meet a need in the community?*
15% weighting
What key beneﬁts (direct or indirect) will the program, project and/or activity bring to communities within the Central Highlands region?*
15% weighting
Complete and attach a Project Plan for project and/or activity, including detailed budget, timeline and risk management*
Max. file size: 256 MB.
15% weighting
Have you supplied two quotes including at least one local quote?
- Yes
- No
5% weighting
Please attach quotes*
Drop files here or

Max. file size: 256 MB.
If no, please provide reason
Demonstrate that attempts have been made to raise funds from other sources by providing details and outcomes of attempts e.g. raﬄes, funding raising initiatives, other grants or subsidies applied for. Describe your current and future plans for your existing funds.
10% weighting
What is your organisation’s contribution toward this program, project and/or activity? e.g. In-kind, organisation revenue
10% weighting
Explain how this program, project and/or activity aligns with your organisation Strategic Plan and attach Strategic Plan.
15% weighting
Attach Strategic Plan*
Max. file size: 256 MB.
Describe how the project has links to regional priorities outlined in Central Highlands 2022 Community Plan Refresh (resourceful vibrant community, integrated quality infrastructure, diverse prosperous economy, healthy natural environment and/or proactive open governance).
15% weighting
Any further documentation (e.g. cover letter, letters of support, etc.)
Drop files here or

Max. file size: 256 MB.
Section E: Certification by organisation
Application agreement*
- By ticking this box, I certify that to the best of my knowledge the information supplied in this application is true and accurate. I have uploaded all requested supporting documents. If the funding is allocated to our program, project and/ or activity, I will be required to accept the CHRC funding conditions and I will complete the acquittal form and return it to CHRC with receipts and invoices.
Privacy statement: Central Highlands Regional Council is collecting your personal information for the purpose of assessing your grant application and/ or finalising your grant requirements. The collection of this information is authorised under the Local Government Act 2009. Some of the information may be given to media for the purpose of promoting your success and council's support. Your information will not be given to any other person or agency unless you have given council written permission or we are required to by law.
Name
First Last

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