Application Form
Individual Achievement Grants
Please ensure you have read through the guidelines and understand the eligibility
criteria prior to applying.
Enquiries: Recreation Officer, Recreation and Wellbeing - 9278 4774
Applicant details:
Name:
DOB:
Gender:
Address
Postcode:
Phone: (H)
(M)
Email:
Parent/Guardian (please provide if applicant is under 18 years)
Name:
Phone: (H)
(M):
Email:
Activity details:
Name of activity:
Event location: National
(within Australia)
International
Date of activity:
(outside Australia)
State & Country where event will take place:
Organising body:
Total cost to applicant:
Briefly describe the activity and how the grant would assist you to participate:
1
Funding:
Have you previously received an Individual Achievement Grant from the City of Boroondara?
Yes
No
If yes, which financial year?
Bank account details:
Bank account name:
Bank account number:
BSB:
Account holder’s signature/s:
Email address for payment remittance:
Application checklist:
Have you attached the following documents?
Proof of residential status within the municipality (e.g. front and back copy of drivers
licence or rate notice with current address) *
Notification confirming selection to participate in the activity in the form of an official
letter from the organising body *
Copy of Health Care Card or Pensioner Concession Card, should you wish to apply for
the 20% additional funding due to financial hardship *
(please notify Council officers of your intention to apply for this additional funding prior to or when sending
through application)
* Application and supporting documents can be sent via post or email if necessary
Name:__________________________________________________
Signature:____________________________ Date:_____________________
Note: Please provide parental/guardian signature if applicant is under 18 years of age.
Privacy Information:
Council collects the information on this form for the purpose of assessing, allocating and processing Individual Active
Achievement Grants. The personal information will be used by Council for that primary purpose or directly related purposes.
The information may also be used to update Council’s customer databases to assist Council in discharging its functions or
providing services, and some information may be disclosed to financial institutions for the purpose of processing payments.
Some information about grant recipients may also be disclosed to the public in Council marketing or promotional activities.
The personal information collected will not otherwise be disclosed to third parties unless permitted or required by law. If the
information is not collected your grant application may not be considered for funding. Requests for access to and/or
amendment of personal information should be made to Council’s Privacy Officer.
OFFICE USE ONLY
Date received
Individual Achievement Grant form
City of Boroondara resident
Letter confirming participation
Approval
Date confirmation letter sent to applicant
ECM
Yes
Yes
Yes
Yes
No
No
No
No
Yes No
2