APPLICATION FORM
STOP!
Before you fill out this form, have you talked to the YCulture Metro Project
Development Officer and read through the YCulture Metro Guidelines?
Where did you hear about YCulture Metro?
Propel website
Propel e-zine
Propel facebook page
Another website – which one? ______________________________________
Word of Mouth
YCulture Metro flyer
Other – please specify _____________________________________________
PART ONE: PERSONAL INFORMATION
1ST CONTACT PERSON
Contact name:
Postal Address:
Date of Birth:
Postcode:
Telephone (H):
(M):
Email:
What is your cultural background?
Aboriginal and or Torres Straight
Islander
English Speaking Background
Others (please specify)
Non English Speaking Background
2ND CONTACT PERSON
Contact name:
Postal Address:
Date of Birth:
Postcode:
Telephone (H):
(M):
Email:
What is your cultural background?
Aboriginal and or Torres Straight
Islander
English Speaking Background
Others (please specify)
Non English Speaking Background
PART TWO: AUSPICE ORGANISATION
The YCulture Metro Officer can easily assist in finding an auspice organisation.
(For more information about auspicing see the glossary on page 12).
AUSPICING ORGANISATION DETAILS:
Name of Organisation:
Postal Address:
Postcode:
AUSPICING ORGANISATION CONTACT:
Name:
Position/Title:
Preferred Contact Number:
Fax:
Alternative Contact Number:
Email:
For your Auspice Organisation please provide:
a) Their Australian Business Number (ABN) OR
b) Complete the ATO’s “Statement by Supplier” Form.
AUSTRALIAN BUSINESS NUMBER (ABN):
ATO STATEMENT BY SUPPLIER FORM
Are they a GST Registered organisation?
Yes
No
Are they an incorporated organisation?
Yes
No
(If yes, please forward a copy of their incorporation certificate. Please note:
Propel Youth Arts WA can only fund incorporated bodies, otherwise you can ask
an incorporated organisation to auspice your project, see attached).
Has the organisation received previous sponsorship from Healthway?
Yes
No
If yes, did the event occur in the past 12 months?
Yes
No
Has the organisation been a recipient of Heathway funding in the last 12
months?
Yes
No
PART THREE: YOUR PROJECT
After you have spoken with the YCulture Metro Project Development Officer,
answer each of the following questions.
1. What is your project called?
2. Please complete the Project Timeline Below, considering the following:
o When will your project start and finish?
o Are you running an event/series of events and if so, when will they
occur?
o When are your marketing deadlines? (Including dates for things
such as poster/flyer printing & distribution, facebook promotion,
media release distribution etc.)
o Are there other important dates in that time we should know
about?
Please ensure your deadlines are REALISTIC and that you leave enough time
to complete your project. Applications with timelines that are impractical will
not receive funding. Please speak to the Project Development Officer if you
are unsure.
**REMEMBER: Your application MUST be submitted at least TWO MONTHS
before the start of your project.
DATE
ACTIVITY DESCRIPTION
2ND APRIL
2012
e.g. Create facebook event & start facebook promotion
3. Please provide a Project Outline.
What’s your project about? Why do you want to do this project? Give us all the important
details of what you’re planning to do and where you’re planning to do it.
4. a) Describe the involvement of young people in your project.
Did they come up with the idea? Will they organise and run it? Are they the ones
who will attend and participate? How will young people be involved? What are
their roles?
4. b) How many young people will be involved in the project?
Please estimate if you don’t have exact numbers. Remember;
o At least two young people must be event organisers.
o At least six young people must be direct participants (e.g. people
attending workshops, people performing, writing, or creating)
o At least fifteen (but ideally up to 100, or more) young people must be
indirect participants (e.g. audience, people attending an event, could be
workshop participants if you are working with a large or many groups.
ORGANISERS:
DIRECT PARTICIPANTS:
INDIRECT PARTICIPANTS:
5. What are the objectives of your project?
What good things will come out of this project for young people? Will it give
them a chance to have their say, show that they could do some great stuff in
their community or let them develop some new skills? (This can be in point
form).
6. a) Who are the professional artists or arts workers involved?
Get hold of their CV’s to attach.
6. b) Please outline how your mentor will be involved, and what skills you
hope to develop.
Will your mentor facilitate workshops? Assist you to curate an exhibition?
Informally work with you to plan an event? Will you learn something new from
your mentor? Or will you expand your skills/knowledge about something you
already do? Is it your first opportunity to share, perform or exhibit your work?
7. Please clearly outline your marketing and promotion plan.
How are you going to promote your project? You might use flyers, posters,
radio, T.V., newspapers, websites, emails, getting out there and talking to
people…the possibilities are endless! Detail your marketing strategy in the table
below.
STRATEGY
DEADLINE
DISTRIBUTION LOCATION
Flyer and poster
design
April 26
Local schools, universities, cafes
Flyers & Posters
printed
May 11
Flyer & poster drop
May 18
8. How will you spread the Drug Aware message?
You could do this through naming/presentation rights, programs, advertising,
logo recognition, PA announcements, signage, role models, distributing health
message brochures, dedicating space to the Drug Aware message in your
program, talk/seminar, newsletter or competition. There are heaps of ways you
can
9. Tick the boxes to tell us how you’re going to make sure your event happens
in a healthy environment
Already
happening
1.
Totally alcohol free venue –
indoor and outdoor
2. Totally smoking free venue –
indoor and outdoor
3. Healthy food choices offered
Will make it
happen
Not an issue
at our event
4. Sun protection measures
introduced in outdoor
settings
10. Support Material
The following checklist gives you a list of the essential support material, and
suggests some other ideas that may strengthen your application. Remember
that support materials must be concise and relevant to your activity.
Please tick the boxes to ensure that we receive all of your attachments.
Essential
Certificate of Incorporation of Auspice organisation
CV of Artist mentor
Letter of support
Optional
Further letters of support (eg from your mentor confirming commitment,
from an organisation involved in your project or who you have worked
with before, from a young person who will be involved in the project)
Quotes for budget items
DVD of your previous work
Examples of promotional designs
Other: _____________________________________
Other: _____________________________________
PART FOUR : YOUR BUDGET
Budget…the money, the cash, and the dollars
TOTAL PROJECT COST
$
(Must not include GST)
AMOUNT REQUESTED IN THIS APPLICATION (UP TO $3,000)
$
(Must not include GST)
If the organisation is registered for GST, then Propel Youth Arts WA will grossup the approved grant for GST liability upon the issue of a Recipient Created Tax
Invoice.
Have you asked sponsors or applied to other funding bodies to support your
event?
If yes, who are they and are they confirmed?
Give us a breakdown of all the incoming and outgoing dollars. Here are a few
tips:
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If you don’t know the exact amounts, put in your best estimate
Include quote from suppliers where possible for large amounts (attach as
support material)
List your specific items under the appropriate headings
Income
Box Office/Gate
Merchandise
$
Expenditure
General
administration, Office
expenses
Promotion
(Advertising, Printing)
$
Program Sale
Documentation
(eg: photographs)
Organisation’s
Contribution
Professional Fees
(artists and
artsworkers)
Running Costs
Grants (please specify
sources and if
confirmed)
Sponsorship (please
specify sources and if
confirmed)
In kind
Other (please specify
sources and if
confirmed)
Requested Healthway
Sponsorship
TOTAL
(Not including GST)
Venue Hire
Equipment Hire /
Purchase
Materials
Other Costs (please
specify)
STOP!
Are these two totals equal? They should be! If your budget does not balance
ask the Propel Project Development Officer for help.
PART FIVE: THE AGREEMENT
If your application is successful these undertakings and conditions will form part
of your contract with Propel Youth Arts WA. Y Culture is presented by the Drug
Aware message.
We agree to:
 Establish a permanent smoke free environment, where possible, in all
indoor areas under our control.
Outdoor areas will be smoke free for the duration of the event/activity.
 Ensure that no person will smoke while representing this sponsorship.
 Promote the Drug Aware message in ALL media publicity including








newspaper, radio and television.
Acknowledge the support of Propel Youth Arts WA
Ensure that all signs, banners, logos and other health promotional
material relating to the health message are prominently displayed at all
times. All returnable materials will be sent back by the due date.
Invite representatives from Propel Youth Arts WA and Healthway to the
sponsored event.
Use the sponsorship funds for the approved purpose only.
Return any unspent money.
Seek approval from Propel Youth Arts WA for any changes related to
sponsorship, including changes to the budget.
Provide within four weeks of the project’s completion, a project report as
outlined by Propel Youth Arts WA.
Acknowledge the right of Propel Youth Arts WA to terminate this
agreement if the sponsorship is not carried out according to the agreed
proposal.
PART SIX: DECLARATION
I declare that the information presented on this form is correct and understand
that if approved by Healthway and Propel Youth Arts WA, we will abide by the
undertakings and conditions above.
STOP!
This form should be signed by the person listed as the auspicing organisation
contacted at the beginning of the application, not the Youth Project
Coordinator/Group contact. Another office bearer should witness this from the
organisation.
AUSPICING ORGANISATION CONTACT:
Print Name:
Signature:
Position:
Date:
WITNESS:
Witness Name:
Signature:
Position:
Date:
ADVICE TO APPLICANTS INVOLVED IN AUSPICING
ARRANGEMENTS
Propel Youth Arts WA requires organisations applying to Propel Youth Arts WA
for Sponsorship to be incorporated. This means that an incorporated
organisation agrees to submit an application to Propel Youth Arts WA under its
own name, and allow its incorporated status to be used on behalf of an
unincorporated applicant in terms of all financial, legal and managerial
functions.
If the application is successful, all correspondence, including the letter of offer
from Propel Youth Arts WA, will be sent (via the applicant) to the CEO or
Chairperson of the auspicing organisation who may choose to be represented in
discussions with Propel Youth Arts WA and the Health Department of WA staff
to confirm sponsorship strategies.
Payment will be made directly to the bank account of the auspicing body. Any
fee for auspicing and coordination, if levied, should be included in the budget
submission and as a general rule, should be no more than 10% of the total
project cost. The application must be submitted to Propel Youth Arts WA a
minimum of two month before the commencement of the event.
A Project Journal and Financial Acquittal is required from successful applicants,
with assistance from the Auspice Organisation where necessary. This can
completed throughout the project and submitted one month after the
completion of the project.
PART SEVEN: AUSPICING AGREEMENT
(auspicing organisation) agrees to ensure
that:
1. The submission has been fully discussed with the applicant and all
responsibilities are understood
2. Sponsorship monies will be spent in accordance with the agreed contract.
3. Propel Youth Arts WA will be consulted and advised of any changes to
the approved program.
4. All contract health promotion strategies will be implemented
5. All required evaluation and financial reports will be sent to Propel Youth
Arts WA on completion of the project or before the specified dates.
Signed:
(Auspicing Organisation Chairperson/CEO)
Print Name:
Signed:
(Project Coordinator 1)
Print Name:
Signed:
(Project Coordinator 2)
Print Name:
PART EIGHT: CHECKLIST
HAVE YOU:
Had lengthy talks about your project and worked through a draft of your
application with the Y Culture Metro Project Officer?
Allowed at least two (2) calendar months from the submission date of
your application to the start of your project?
Read and understood all of the application form?
Filled out every section of the application form?
Got your auspicing organisation to fill in their details and sign the
declaration?
Included one of the organisation’s incorporation certificate?
Include a copy of the Auspicing Agreement?
Provided an accurate and balanced budget (excluding GST)?
Included any other support material such as letters of support and letters
of agreement from participating artists?
Kept a copy of your application?
Check that your artists have current Working with Children Checks and
Police Clearances.
YES TO ALL OF THE ABOVE? Send us your application!
EMAIL IT to [email protected]
SEND IT to Ashlee Giblett, PO Box 8238, Perth WA 6849
DELIVER IT to Arts House Building (Downstairs from the Blue Room Theatre)
53 James St Northbridge
CHECK TO MAKE SURE IT GETS TO US BY PHONING THE YCULTURE
PROJECTS DEVELOPMENT OFFICER, ASHLEE on 08 9328 5855
The Y Culture Metro Project Development Officer will notify you about your
result within three weeks of submitting your application.