Office use only
TRIM:
Grant no:
Project coordinator:
Youth Engagement Scheme
grant application form
Applicant’s details
Organisation name:
Postal address:
Suburb:
State:
Postcode:
State:
Postcode:
Street address:
Suburb:
Preferred contact person
All application correspondence will be directed to this person.
Title:
First name:
Last name:
Position:
Business phone:
Mobile phone:
Website:
Email:
Business details
Does your organisation have an ABN?
Yes
No
ABN:
You can find your Australian Business Number (ABN) online.
Is your organisation registered for GST?
Yes
No
Is your organisation not-for-profit?
Yes
No
Is your organisation incorporated?
Yes
No
Incorporation number:
You can find your incorporation number online.
(please attach a copy of the Incorporation Certificate)
Does your organisation have current public liability insurance? (please attach a copy of
the certificate of currency)
Yes
No
Bank account name:
BSB number:
Bank account number:
Full name of financial institution:
Project information
Please keep your application concise.
Project title:
Project start date:
Project end date:
Project location:
Have you contacted your local Department of Sport and Recreation office?
Yes
No
If yes, who did you discuss your project with?
Consultant’s name:
Is this a new project? (If no, how will this build upon previous programs or funding?)
Yes
No
Comment:
Child safeguarding information
Keeping children safe is a whole of community responsibility. If you are delivering a project
that involves children under the age of 18, we strongly encourage you to understand your
organisations responsibilities. This includes complying with the Working with Children Check
(Criminal Record Checking) Act 2004, developed to work alongside other child safeguarding
strategies to help protect children in Western Australia.
Use the following resources to find out whether your organisation is child safe:
 Safe Clubs 4 Kids workshops and resources
www.dsr.wa.gov.au/support-and-advice/safety-and-integrity-in-sport/sportsafe/safeclubs-4-kids
 Working with Children Check legislation
www.workingwithchildren.wa.gov.au
 ‘Club toolkit’ on the Play by the Rules website
www.playbytherules.net.au/features-mainmenu/club-toolkit
1. *DSR may wish to provide your contact details to the WA Sports Federation (WASF) to
obtain Working with Children Check support.
2. *DSR will subscribe the preferred grant contact for this application to the DSR industry
newsletter, no matter the outcome of this application.
*Please acknowledge that you understand and agree to the two statements above
(Put ‘X’ here)
1. Grant amount requested
Amount of funding requested
(Excluding GST)
Contribution from organisation
(Excluding GST)
Sponsorship from other organisations
(Excluding GST)
Program budget total excluding GST
2. Project description
Provide an overview of the project and project components.
E.g. Who is the project targeting? What are the strategies that will be used to deliver the
project? Where will the project be delivered (metropolitan or regional)? How many people do
you anticipate being involved? Please ensure all essential project components (as
detailed in grant guidelines) are addressed.
3. Project implementation
Provide a plan to indicate how the project will be implemented including the steps taken to
reach scheme objectives, project timeline, etc.
4. Rationale
Outline the evidence and rationale supporting your project and approach, including when and
where program delivery is occurring (e.g. is program delivery occurring during high risk
times?).
5. Target group
Who is the target group? How will you engage them in the program? What experience does
your organisation have in engaging this group?
6. Partnerships
What funding partnerships and/or in-kind support have been committed to this project?
Partners may include relevant local government, state sporting association, other state
government agencies, etc.
7. Community engagement
What consultation with local community members, service providers and other relevant groups
has occurred? Please list all below.
Group/person
Consultation medium/ Outcomes
technique
E.g. Western
Australian Police
Face to face meeting
WA Police to support the project
through participation in a number of
basketball sessions and referring
young people into the program.
8. Capacity to deliver
Does your organisation have sufficient staff and resources to deliver the project? Can your
organisation demonstrate experience in delivering similar projects? Can this program still be
delivered if DSR cannot commit to fund 100% of your requested amount?
9. Risk management
Complete a risk management review and identify strategies to address the risks. E.g. are all
your participants covered by insurance? A template risk matrix and risk register are available
on the DSR website.
10. Project legacy and evaluation
What strategies are in place to sustain project outcomes beyond the funding period? If training
of personnel has occurred, what are the long term benefits? How will you evaluate project
objectives?
11. Project budget
Please list all anticipated costs of your activity in as much detail as possible:
Revenue
Proposed amount
Funding source
Department of Sport and
Recreation (DSR)
Requested from DSR
Supplied by your organisation
From any other organisations
(please specify)
Participant fees (if relevant)
Other revenue items
Total revenue
Expenditure item
(e.g. administration costs, venue hire, program
coordinator fees, workshop facilitator)
Total expenditure
Proposed amount
Funding source
12. Privacy statement and statement of disclosure
The Organisation acknowledges and agrees that this Application and information regarding it
is subject to the Freedom of Information Act 1992 and that the Grantor may publicly disclose
information in relation to this Application, including its terms and the details of the
Organisation.
Any information provided by you to the Department of Sport and Recreation can be accessed
by you during standard office hours and updated by writing to Department of Sport and
Recreation or calling 08 9492 9700. All information provided on this form and gathered
throughout the assessment process will be stored on a database that will only be accessed by
authorised departmental personnel and is subject to privacy restrictions.
The Department of Sport and Recreation may wish to provide certain information to the media
for promotional purposes. The information will only include the applicant’s club name, sport,
location, grant purpose and grant amount.
Applicant’s certification
I certify that:
The information supplied is to the best of my knowledge, true and correct.
I have the authority, as vested by the Board/Committee/Council/CEO, to submit this
application by electronic transmission.
Name
Position
Signature
Date
If you have any queries about your eligibility or the details required when applying for this
grant, please contact the Department of Sport and Recreation on 08 9492 9700 or email
[email protected]
Please return a completed and signed copy of this application to:
Department of Sport and Recreation
PO Box 329 LEEDERVILLE WA 6903
Application checklist
(for your information only)
Have you discussed the project proposal with a member of the Department’s Community
Inclusion Team or the nearest regional office prior to submitting an application?
Yes
No
Comment:
Does the proposed project address all essential components as outlined in the grant
guidelines?
Yes
No
Comment:
Does your organisation propose appropriate strategies to engage the target group?
Yes
No
Comment:
Does your organisation have demonstrated experience in working with disengaged youth?
Yes
No
Comment:
Have you engaged other community organisations and/or departments to develop funding
partnerships and/or in-kind support?
Yes
No
Comment:
Has your organisation demonstrated its engagement with local community members and/or
community organisations that work closely with the target group?
Yes
No
Comment:
Has your organisation demonstrated it has the capacity (human/financial resources) to deliver
the project?
Yes
No
Comment:
Are there strategies in place to ensure project outcomes will be sustained beyond the funding
period? Has your program developed an evaluation process?
Yes
No
Comment:
Budget
Is the project budget comprehensive and details all reasonable income (e.g. participant fees,
sponsorship, other grants and expenditure (venue hire, course fees, employment)?
Yes
No
Comment:
Are all project budget items requested to be funded by the department eligible?
Yes
No
Comment:
Note: Funding cannot be used to purchase ineligible items.