Small Community Grants Program
2009 / 2010
Round 2
Application Form
Applications Close 12 March 2010
Name of Organisation: ____________________________________________________
Project Contact Person: __________________________________________________
Contact Person’s Position: ________________________________________________
Postal Address: _________________________________________________________
Contact Tel:_____________________________________________________________
Name of Your Project:
Contact Email:___________________________________________________________
________________________________________________________________________
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Amount of Funding Sought $ __________________
Small Community Grants Program
2. Project Description
A. What you want to do?
B. Why you want to do it?
C. Expected project start and end dates
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Small Community Grants Program
D. What are the benefits of your project, to the community?
E. Any other information you think we need to know.
3. Project Budget

Please indicate your proposed budget for the project.
Proposed Project INCOME
Council Grant (i.e. Amount requested)
$________________
Your groups financial contribution (if applicable)
$________________
Your groups in kind contribution (if applicable)
$________________
Other funding sources
$________________
TOTAL PROJECT INCOME (should equal Total Project Expenditure)
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$________________
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Small Community Grants Program
4. Other Budget Related Information:
A. Indicate what you intend to spend grant money on.

If you do not have exact figures, please provide best estimates.
B. Do you have any relevant quotes from suppliers for any materials or services involved in your project?
Yes / No

Please attach any quotes or other relevant material to your application
C. Please indicate why financial assistance is required.

Be sure to explain why you cannot use any existing funds or expected profits to complete your project
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Small Community Grants Program
D. If you do not receive the full amount requested, can/will the project still go ahead?
Yes / No
5. Number of members in Yankalilla District: ______________________
7. Is your group Incorporated or auspiced by an Incorporated Association? Yes / No
* If you answered no, then you are not eligible, as applicants must be incorporated or auspiced by an incorporated body in order to receive
grant funding.
Provide details of the auspice organisation, if applicable. This parent body must also sign this application.
8. List your Australian Business Number (ABN) ______________________
9. Are you registered for GST?
Yes / No
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Small Community Grants Program
Please confirm you have completed the following (with a tick):
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Read the guidelines
Attached Financial Statements for last year (or provided an explanation why this
is not possible)
Supplied your contact details
Provided a Clear Budget
Attached supporting financial quotes, if relevant
Confirmed that your organisation is Incorporated or auspiced by another
Incorporated body
Kept a copy of this completed application, for your records
Declaration and Undertaking by Applicant
If this application is successful, we undertake to:

Supply Council with a suitable invoice dependent on GST status, for the grant amount.

Use the grant only for the purpose outlined in the application.

Seek written approval from Yankalilla Council for any significant changes in the budget or project.

Spend grant monies within stated period.

Acknowledge Council’s assistance in any material relating to the project.

Complete and submit a Funding Acquittal Form detailing income/expenditure, within three (3) months of
completing the project and no later than 31 December 2009.

Return any unspent grant monies with the Financial Acquittal Form.
Signature: _______________________
(Committee member)
Signature: _______________________
(Committee member)
Name: ___________________________________
(Please print clearly)
Name: ___________________________________
(Please print clearly)
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Small Community Grants Program
Date: ____________________________
If you are auspiced by an incorporated association, a representative from that parent body will also need to sign this
application below:
Signature: ________________________
Name: ___________________________________
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