2015 Wentworth District Capital Limited Community Development Funding Application
2015 Community Development Funding Application
APPLICATION CHECKLIST – THIS MUST BE
COMPLETED
Please ensure that you have ticked of each of the following grant
application funding criteria:FORMAL QUOTES - one, and preferably two, for each budgetted item
to be purchased or work to be completed by outside agencies.
CURRENT BUSINESS PLAN - a copy of your Organisation’s current
business plan must be included if your application exceeds $20,000.
ANNUAL REPORT (2014) INCLUDING FINANCIAL STATEMENTS
AND WHERE APPLICABLE AUDITOR’S/REVIEWER’S REPORT - a
copy of your most recent must be attached.
LETTERS OF SUPPORT, PLANS etc - attach any letters of support,
plants etc. which you believe will assist us in evaluating your application
for funding and any additional information that you believe may be
relevant.
COPY OF CURRENT BANK STATEMENT
COPY OF WENTWORTH SHIRE COUNCIL DOCUMENTATION (if
applicable)
COPY OF CURRENT CERTIFICATION OF REGISTERED CHARITY (if
applicable)
A COMPLETED STATEMENT OF SUPPLIER FORM IF REQUIRED
(contact Jill Davidson 50273518 for copy of form)
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2015 Wentworth District Capital Limited Community Development Funding Application
2015 Community Development Funding Application
CLOSING DATE : Friday 17 April 2015
Important information for Application completion:
 Only typed applications will be accepted.
 All applications must contain at least one, and preferably two, formal quotes for each
budgetted item to be purchased or work to be completed by outside agencies.
 A copy of your Organisation’s current Business Plan must be included if your
application exceeds $20,000.
 A copy of your most recent Annual Report (2014), including Financial Statements
where applicable and Auditor’s/Reviewer’s Report, must be attached.
 Attach any letters of support, plans etc. which you believe will assist us in evaluating
your application for funding and any additional information that you believe may be
relevant.
Taxation Requirements
To comply with Australian Taxation Legislation and to preclude implementation of
Withholding Tax provisions, community groups and organisations applying for Community
Development Grant Funding must provide either an Australian Business Number (ABN)
or complete a Statement by Supplier form (reason for not quoting an Australian Business
Number (ABN) to an enterprise) available from the Australian Taxation Office (website) or
Wentworth District Capital Ltd (WDCL) who will forward this form to successful applicants
that have indicated that their organisation does not hold an ABN number. The Statement
by Supplier Form is to be completed and returned to WDCL prior to any payment being
made.
Goods & Services Tax (GST)
Not for profit community organisations must be registered for the GST if their annual
turnover is $150,000 or more. However some community organisations with lower
turnover may have chosen to register in order to claim back the GST they pay on
purchases involved with running their organisation. Grants and Sponsorships paid to
organisations that are registered for the Goods and Services Tax will be subject to GST.
Where your organisation is registered for GST, funding for successful applicants that are
registered for GST will be “Grossed up” to include the GST amount.
WDCL will issue all successful applicants with a recipient created Tax Invoice.
When completing the budget section of the application form (Section 10) whether
or not your organisation is registered for GST, all monies shown should be GST
excluded.
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2015 Wentworth District Capital Limited Community Development Funding Application
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Name of Organisation:
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Project Title:
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Postal Address:
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Contact Person/s:
Name: ………………… Position……………………………….Phone…………………………
Email: ……………………………………................................
Name: ………………… Position……………………………….Phone…………………………
Email: ……………………………………................................
Are you a Deductible Gift Recipient or Registered Charity?
provide copy of current certification.
Yes / No
If yes, please
Is your group incorporated? Yes / No
Incorporation Number:…………………………. ABN: ……………………………………..
Are you registered for Goods & Services Tax (GST)?
Yes / No
Is your Organisation a customer of the Wentworth & District Community Bank® Branch
Bendigo Bank?
Yes / No
2015 Wentworth District Capital Limited Community Development Funding Application
Project information
Dollar Value of Funding sought: $.............................
1. What does your organisation do? (Please provide information on mission statement,
founding date, major programs, attributes, number of members, staff and/or
volunteers.)
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2. Please fully outline how your organisation, committee and/or members have
supported the Wentworth & District Community Bank® Branch (whether staff
and/or volunteers are customers of the WDCBB, does your organization bank with the
WDCBB, how does your organization actively encourage community members to bank
with WDCBB)
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3. Please fully outline your proposed project, including location. (What particular
need will it meet, who will benefit, where will your proposed project be located)
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4. Please advise how many people in the community this proposed
project/venture/facility will affect/assist (also identify/include visitor numbers, how
many people are affected both directly and indirectly)
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2015 Wentworth District Capital Limited Community Development Funding Application
5. Please detail fundraising efforts and/or contribution to be made by your
organisation towards the project? Other Partner organisations? (What is the
percentage of the project that will be self-funded by your organisation, list other partner
organisations, list fundraising events/promotions, include Federal/State/Local
Government funding sought, other stakeholders involved with the project)
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6. How will your organisation manage this project? (Will an outside contractor be
used, will this be undertaken through Wentworth Shire Council, is it to be selfmanaged).
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7. What is your projected time frame for commencement and completion of your
project?
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8. Is the proposed grant expenditure to be applied outside of the Wentworth Shire
and if so, what proven benefits will be available to Wentworth Shire residents?
(Will the project include/assist residents in Wentworth Shire).
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2015 Wentworth District Capital Limited Community Development Funding Application
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9. Has your Organisation previously received Wentworth & District Community
Bank® Branch Bendigo Bank funding? If so, please complete details below.
Year
Project Title
Funding Received $
Evaluation Form
returned Y/N
10. Please complete the table below to fully outline where project funds will come
from, and how they are budgeted to be expended. Refer Attachment 1 for
Example.
Budgetted
Item
Community Bank®
Funding Sought
Your Organisation’s
Contribution
Direct
In-kind
Third Party
Contribution
Direct
In-kind
Total Cost
Excluding GST
TOTAL
Please provide notes below to fully clarify above table.
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11.
Please outline any promotional opportunities your Project / Event may
provide for the Wentworth & District Community Bank® Branch. (Such as signage,
media coverage and/or exposure (radio, television), brochures, advertising, householder
drop, FaceBook/twitter inclusion, newsletters, etc)
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2015 Wentworth District Capital Limited Community Development Funding Application
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12. Is the Community Bank funding catalytic to the project going ahead? YES / NO
13. Please identify the Economic Outcomes, i.e. impacts resulting from the investment
that contribute to economic outcomes for the local community, by placing a tick
next the relevant economic impact indicator below:Usage Value
More than expected
As expected
Less than expected
Unknown
Local Inputs
All local inputs
The level of usage by the community of the project in
which the investment will be made:The investment will be used much more than expected
The investment will be used more or less as expected
The investment will be used much less than expected
The project has not been completed, hence actual usage is
unknown
This provides an assessment of the extent to which
recipients are able to purchase their supplies locally. Both
the supplies associated with the funding received from
the Wentworth & District Community Bank® branch as
well as a more general assessment of the organisation’s
procurement process
All supplies are purchased locally (estimated as approximately
100% of supplies)
Mostly local inputs
Most supplies are purchased
approximately 66% of supplies)
Some local inputs
Some supplies are purchased locally (estimated as
approximately 33% of supplies)
No supplies are purchased locally (estimated as 0% of
supplies).
This is a yes/no response to whether the investment is
considered to have significant further economic outcomes.
The response will be yes only if the investment is considered
critical to the community in a way that cannot be captured by
the more standard economic impact assessment tools (as per
the usage value and flow-on economic stimulus), because it is
fundamental to the community’s prosperity. Examples here
may include schools, hospitals, or even important sporting
clubs or hospitality venues, where these are facilities that
provide the core foundation for why people live in the town.
Such a facility could be considered core if when it ceased to
exist, it could reasonably be expected that other business and
populations would move away from the community. It is
expected this will only be the case in exceptional cases.
No Local inputs
Significant further
economic outcomes
Yes
OR
No
locally
(estimated
as
2015 Wentworth District Capital Limited Community Development Funding Application
14. Please identify the following Social Impacts which the project/event/facility would
provide by indicating the appropriate response next to each outcome:Social Impacts
Human and Social Capital Outcomes
None
Minor
Significant
Pride in Community - Occurs when an investment helps to foster a level of
None
Minor
Significant
None
Minor
Significant
Participation - Occurs when community members are provided with the opportunity
None
Minor
Significant
Human Capital - Occurs when an investment builds the skills and/or knowledge
None
Minor
Significant
None
Minor
Significant
Wellbeing - Captures any improvement to the quality of life for persons directly
None
Minor
Significant
None
Minor
Significant
Networking Within Organisations - Networking – within organisations is
satisfaction among community members as a result of improving the perceived
status of their community, from the point of view of both community members and
external visitors to the town.
to become involved in a community group, activity or event. The level of participation
may range from an ongoing and regular commitment to a one-off or annual instance
Volunteerism - Occurs if the investment attracts community members to offer inkind labour to community organisations or events. Volunteering takes many forms and
may be performed by a wide range of people. Volunteers can be specifically trained in
the areas they work in; other volunteers serve on an as-needed basis.
of those directly affected. Skills and/or knowledge can be developed via a variety of
different channels – this can range from formal training through to life skills coaching
sessions.
affected by the investment. This includes improvements to physical health and/or
mental health.
Personal Safety- Improves the physical safety of the persons affected by the
investment. This can take the form of any improvements or assets that reduce
exposure or risk to harm, accident or any event that could be categorised as causing
physical damage to individuals
where an investment assists an organisation to improve its internal governance,
coordination and internal relationships
Networking Between Organisations - Networking – between organisations
is where an investment assists an organisation to build links and relationship with
members and other groups in the community. This social outcome is important for
capturing investments that facilitate connections within communities
15. Please identify the following Environmental Impacts which the project/event/facility
would provide by indicating the appropriate response next to each impact:Environmental
Impacts
None
Minor
Significant
None
Minor
Significant
Impacts on the natural or physical assets of the community and
its broader environment
Urban Amenity - The provision of facilities and/or improvement made to the urban
None
Minor
Significant
Sustainability - Any actions or products that reduce consumption of non-renewable
landscape. It can include the construction of an asset, improvements to the aesthetics
of urban spaces, or protection of man-made heritage assets
Natural Amenity - The provision of facilities and/or improvement made to the
natural landscape. This will typically include any improvements to the aesthetics (i.e.
natural beauty) of the community’s natural environment (e.g. tree plantings) and
protection of natural assets.
resources, such as energy and water.
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2015 Wentworth District Capital Limited Community Development Funding Application
16. Conditions of the Grant
We, being authorised officers of the organisation in making this declaration, confirm and
agree to the following:a) The information given in this application, including any attachments hereto are true
and correct in every particular.
b) As the level of funding to be provided by WDCL is yet to be determined, we the
applicant / grantee agree to allow WDCL to issue us with a Recipient Created Tax
Invoice (RCTI) for any taxable supplies it makes in relation to the proposed
project/activity.
c) That any monies received from WDCL must be spent on the approved activity as
outlined in this Community Development Funding application.
d) Make appropriate public acknowledgment of the Wentworth & District Community
Bank® funding source / sources for the project.
e) Any monies not expended on completion of the project will be returned to WDCL, to
be once again pooled and made available for other worthy community funded projects.
f) To provide WDCL with a completed evaluation / project acquittal report form detailing
that the monies have been expended in accordance with this funding application.
g) That failure to comply with these conditions may preclude your organisation from
accessing further grant funding in the future.
h) To indemnify and keep indemnified and to hold harmless, WDCL, its servants and
agents and each of them from and against all actions, costs, claims, charges,
expenses, and damages whatsoever which may be brought or made or claimed
against them or any of them arising out of or in relation to a community project or event.
i) We understand that any variation from the above conditions will require negotiation
with WDCL’s Grants and Sponsorship committee.
To be signed by two different signatories on behalf of the applicant organisation.
(signatories must be over 18 years of age)
Name:
Name:
Position Held:
Position Held:
Signature:
Signature:
Date:
Date:
Return this application together with relevant attachments to Jill Davidson:
By email:
By mail or hand delivery:
jill@wdcl.com.au
36-38 Adelaide Street, Wentworth NSW 2648
If you have any queries regarding the form please telephone Jill 50273518.
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2015 Wentworth District Capital Limited Community Development Funding Application
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Attachment 1:
EXAMPLE ONLY:
Community Development Funding Application
Wentworth District Childcare Centre $610,000
Budgeted Item
Feasibility,
Plans &
Permits
Site
Preparation
Community Bank®
Funding Sought
Your Organisation’s
Contribution
Direct
In-kind
Third Party Contribution
Direct
In-kind
$20,000
$20,000
$25,000
Construction
$15,000
Fit Out
$15,000
$20,000
$15,000
$15,000
$25,000
$335,000
$350,000
$100,000
$115,000
Land
TOTAL
Total Cost
$435,000
$100,000
$100,000
$125,000
$610,000
Please provide notes below to fully clarify above table.




Site preparation $25,000 in kind labour donation from local Dig Deep earthmoving
contractors – Quote attached.
Construction funding sourced from Kevin ’07 Ready Grants Program $335,000 –
approval letter attached. Additional $15,000 by volunteer labour for painting &
decorating – Estimations of dollar value attached.
Community fundraising efforts $15,000 towards fit out – Copy of Bank statement
attached.
Wentworth Shire Council – Land donation $100,000 – Copy of Shire undertaking
attached.