Optus Connecting Communities Grants Program - Application Form for Not For Profit Organisations 2010/11

Optus Connecting Communities Grants Program - Application Form
How to Apply
 
1.  A project application can be submitted by either an Optus employee applying for a grant on behalf of a Not For Profit organisation OR directly by a Not For Profit organisation. Both parties cannot submit applications for the same grant. Only one application per project can be submitted by either an Optus employee or a Not For Profit organisation, not both.
 
   The following application is for Not For Profit organisations applying for a grant.
 
   If you would prefer an Optus employee to apply on your behalf please direct the employee to the Optus Connecting Communities Grants Program section of the Optus Intranet.
 
2.  Before completing this form please read the Optus Connecting Communities Grants Guidelines, Selection Criteria and Terms & Conditions
 
3.  All Not For Profit organisations applying for a grant must have a current Deductible Gift Recipient Number to be eligible to apply.
 
4.  Not For Profit Organisations must complete all sections of the application form below.
 
5.  Please be aware that you will not be able to save your application for editing at a later date. A word version of the application is attached as a working draft prior to your submission (please note: the word document is not to be uploaded as an application submission. You will need to cut and paste from the word document into the online form when you are ready to submit your application).
     MS-Word version of the application Click Here
I have read and understood the Optus Connecting Communities Grant Application Guidelines, Selection Criteria and Terms & Conditions. *
YES
Section A - Not For Profit/Charitable Organisation Details
Organisation name: *
Is this a Not For Profit
organisation? *
Yes No
The organisation must be a Not For Profit organisation to be eligible for a Connecting Communities grant.
Is this Not For Profit organisation registered as a GST taxpayer? * Yes No
Do you have a ABN Registration No? * Yes No
Please provide your ABN Registration No: *
Successful applicants registered as GST taxpayers will be required to supply a tax invoice for the grant amount. Non registered organisations will receive GST exclusive amounts and will also be required to submit an invoice to Optus.
Do you have a GST Registration No? * Yes No
Please provide your GST Registration No: *
Successful applicants registered as GST taxpayers will be required to supply a tax invoice for the grant amount. Non registered organisations will receive GST exclusive amounts and will also be required to submit an invoice to Optus.
Do you have a ACN Registration No? * Yes No
Please provide your ACN Registration No: *
Successful applicants registered as GST taxpayers will be required to supply a tax invoice for the grant amount. Non registered organisations will receive GST exclusive amounts and will also be required to submit an invoice to Optus.
Do you have a current Deductible Gift Recipient Status? * Yes No
The organisation must be registered as a Deductible Gift Recipient to be eligible for a Connecting Communities grant
What is your Deductible Gift Recipient Endorsement Number? *
If you do not have a DGR number please provide ABN number here. A copy of your DGR Letter will still be required via the Supporting Files Section at the end of this online application.
Organisation background and purpose: *
    (50 words)
Section B - Not For Profit Organisation Contact Person
Title: *
Given Name: *
Surname: *
Position: *
Phone: *
include Area code eg 0280824444
Email Address: *
Section C - Not For Profit Organisation Postal Address
Address: *
Suburb: *
City: *
State: *
Post Code: *
Country: *
Section D - Project Information
Please ensure that you have read the Connecting Communities Grants Guidelines, Selection Criteria and Terms & Conditions before completing this section.
Project Title: *
Brief description of the project: *
    (50 words)
Project location: *
    (30 words)
Grant Categories: *
Some projects may be designed to assist one or all of the categories provided. Please indicate by choosing the correct option(s).
Disengaged Youth - improving education, life skills & knowledge
Social Inclusion - Providing access to commnuication
Social Inclusion - Connecting disengaged communities
What is the need to be addressed in the community relating to Social Inclusion or Disengaged Youth? *
    (50 words)
Does your project integrate information and communication technologies to reconnect disengaged young people and/or reduce social isolation for those in need? *
    (50 words)
In bullet points list the project objectives: *
    (50 words)
In bullet points list the project outcomes and how they will be achieved? *
    (50 words)
Who will be involved in the project – participants, organisers/co-ordinators and community groups? *
    (50 words)
How many people will the project impact including specific demographic or regional aspects? *
    (50 words)
How will the project be evaluated and by whom? *
    (50 words)
How will Optus be promoted? *
    (30 words)
Are there any project risks that Optus should be made aware of? * Yes No
If Yes please describe: *
    (50 words)
Is this a new or existing project? *
What are the project timeframes? *
Successful recipients are expected to spend the money before 31 March 2011
Is this the first application you have submitted to Optus Connecting Communities Grants program? * Yes No
Were you referred to this program by an Optus Employee? * Yes No
If Yes please provide the Employee's Name: *
Section E - Project Budget Details
Please ensure you have read the Connecting Communities Grants Guidelines, Selection Criteria and Terms & Conditions before completing this section.
How much funding are you applying for? *
Optus Connecting Communities Grants are for minimum $1000 and maximum $5000 inc gst.

$
Please complete the expenditure breakdown below for the grant amount you have applied for. *

(note: Operating and Administration costs related to maintaining the existence of the Not For Profit organisation will not be considered for funding. These include: utility costs, general office supplies, labour costs, postage and couriers, maintenance, repairs, office equipment).

Expenditure Breakdown of Grant Amount requested Cost
  TOTAL   $  
 
How much will the project cost in total? *
Total cost must be equal to or above the amount you are applying for

$
Please list additional funding sources: *
List names of trusts, foundations, corporations or other funding sources towards this project

Please confirm that the grant amount will be used and applied soley for the purpose of the project stated in your application for funding * Yes No
Final Checklist
I have provided the following information:*

    • Completed Online Connecting Communities Application
    • GST Registration/ABN/ACN Number

YES