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Grant Acquittal Form

Section A: Applicant Details
Organisation:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact person for this organisation:*
First Last
Position*
Phone:*
Email:*
Section B: Grant Details
Which funding round was approved?*
- Round 1 (February)
- Round 2 (August)
In which year was the funding round approved (for example, 2020)?*
Which category was approved?*
- Community Assistance Grant
- Sport and Recreation Assistance Grant
- Community Improvement Grant
Amount approved:*
Title of project funded:*
Date notified of grant approval (refer to date of CHRC letter of approval):*
MM slash DD slash YYYY
Extension approved?*
- Yes
- N/A
Length of extension:*
Section C: Additional Information
Financial summary:*
Project expenditure items Quoted expenditure Actual expenditure
Project receipts upload*
Drop files here or

Max. file size: 256 MB.
Please upload any receipts for your project expenditures.
Preferred payment type:*
- Cheque (address details to be provided below)
- Electronic Funds Transfer (bank details to be provided below)
Address details for cheque:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank details for Electronic Funds Transfer:*
Account name BSB Account number
Was there any media coverage?*
- Yes
- No
Please specify type of coverage:*
- Newspaper
- Radio
- Newsletter
- Other
Please attach evidence of coverage:*
Drop files here or

Max. file size: 256 MB.
How and when has council been acknowledged?*
Section D: Certification by Organisation
Name*
First Last
I hereby certify that I have been authorised to prepare and submit this acquittal on the above mentioned group/organisation and the information contained herein is a true and correct record to the best of my knowledge. On behalf of the above mentioned group/organisation, I agree to accept funding in accordance with the CHRC community grants program guidelines and associated conditions.
Position:*
Date*
MM slash DD slash YYYY

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Project expenditure items	Quoted expenditure	Actual expenditure

Account name	BSB	Account number

Grant Acquittal Form

Section A: Applicant Details

Section B: Grant Details

Section C: Additional Information

Section D: Certification by Organisation

Emergency Management Dashboard