KARI COMMUNITY
PROGRAMS
COMMUNITY GRANTS
APPLICATION
APPLICATION FORM
Please Note: All questions contained within this application must be answered in full. If you
need support to complete the application please contact us. If incomplete your application
will not be considered.
1. APPLICANT INFORMATION
1.1) Your name:
1.2) Are you applying as
an individual or on
behalf of an
organisation?
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☐ Individual
☒ Organisation
Note: If you are applying as an individual please ensure that a
‘Statement By Supplier’ is attached to this application and
proceed to Question 1(j). If you are applying on behalf of an
organisation please proceed with questions. For more
information see:
http://www.ato.gov.au/businesses/content.asp?doc=/content/
38509.htm
1.3) Business Name:
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1.4) Trading Name:
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1.5) Australian Business
Number (ABN):
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1.6) Address:
Street Address Click here to enter text.
Suburb: Click here to enter text.
Postcode: Click here to enter text.
1.7) Telephone Contact:
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1.8) Mobile Contact:
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1.9) Email:
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1.10) Briefly outline the
purpose and vision
of your
group/agency.
Please include
information about
current activities
that you provide
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1.11) Is your group/organisation an incorporated body?
1.12) I am an Aboriginal Person
1.13) Our group/organisation services Aboriginal people only
2. PROGRAM DETAILS
☐ Yes
☐ Yes
☐ Yes
☐ No
☐ No
☐ No
2.1)
2.2)
What is the title of the project: Click here to enter text.
Briefly provide an overview of your request (under 100 words):
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2.3)
Please outline the target group and the total number of participants (e.g. 12
Aboriginal boys aged 0-6):
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2.4)
Please select one or more of the objectives and explain how it relates to your
project?
☐ Improve participation
How? Click here to enter text.
☐ Improve self – esteem
How? Click here to enter text.
☐ Strengthening culture
How? Click here to enter text.
☐ Creates opportunities
How? Click here to enter text.
2.5)
Please outline your experience in delivering this program/project, or similar
programs/projects:
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3. PROJECT BUDGET
3.1) Please provide a detailed costing for your proposed program/initiative. This budget
must include all proposed expense items. Maximum budget allocation is $3,500.00
inclusive of GST. ** NOTE: Budgeted items are limited to resources that directly benefit
the participants such as uniform, entry fees etc. The following items will NOT be
covered; accommodation, transport and fuel costs, food purchases from major retail
outlets such as Woolworths, Coles etc. If you are not sure, please contact us. All items
and costs listed must match all attached invoices or quotes. Detailed invoices and/or
quotes MUST be attached or the application will be deemed ‘incomplete’ and will not
be assessed.
AMOUNT (Inc. GST)
PROJECT ITEM
$
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
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$ Click here to enter text.
TOTAL AMOUNT (Inc.
$ Click here to enter text.
GST)
3.2)
KARI preferences partnerships over sponsorships. Will you, your group or your
organisation be contributing to the cost of this project?
☐ Yes
☐ No
Amount: $Click here to enter text.
3.3)
Based on your answer to question 3.2, how much funding are you requesting from
KARI Aboriginal Resources Inc. (Including GST)?
Amount: $ Click here to enter text.
4. IMPLEMENTATION
4.1)
Please indicate how you will ensure funds are spent by the expected date:
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4.2)
Please provide an outline of how you will promote your program, including how you
will acknowledge KARI’s sponsorship in your marketing (200 words max):
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4.3)
If you are successful in your application, you will be required to submit a final
evaluation report on completion of the project. Describe how you will monitor and
evaluate your program (200 words max):
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5. FINANCIAL DETAILS
5.1) Financial Institution
Name:
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5.2) Branch:
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5.3) Financial Institution
address:
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5.4) Account Name:
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6. ATTACHMENTS
6.1)
Please list the attachments to this application: (Please include information regarding
your organisation, any relevant promotion material, any invoices and referees that
support your project)
i. Click here to enter text.
ii. Click here to enter text.
iii. Click here to enter text.
iv. Click here to enter text.
v. Click here to enter text.
vi. Click here to enter text.
7. TERMS AND CONDITIONS
All recipients of funding under the KARI Community Program Grants process must abide by the
following terms and conditions;
7.1)
7.2)
7.3)
7.4)
7.5)
7.6)
All information provided to KARI Aboriginal Resources Incorporated within this
application must be true and correct.
The funding provided under this Community Grants Program must be used for the
specific purpose for which it was funded.
If the commencement or completion of the approved project is delayed for any
reason, the recipient must notify KARI at the earliest opportunity and provide such
evidence as is requested to justify the reason for the delay.
Recipients must submit an evaluation report to KARI following the completion of the
program for which funding was provided.
All evaluations and relevant documentation relating to the Program/Initiative MUST
be received by KARI no later than one calendar month after the project has been
completed.
All invoices should be addressed to:
Community Programs Grants
PO Box 207
LIVERPOOL NSW 1871
7.7)
7.8)
7.9)
Should the Program/Initiative fail to eventuate then all funds will immediately be
returned to KARI.
KARI Aboriginal Resources Inc reserves the right to suspend or revoke the agreed
funding:
i. If there is a breach of any of the Terms and Conditions.
ii. The funds were not applied to the agreed project.
Should your application be successful you must agree to the following:
i. I/we will execute the formal funding agreement provided by KARI.
ii. I/we will immediately apply the funding to the project and provide all original
receipts and invoices to KARI as and when requested.
iii. The purchased goods/resources services must be utilised for the project activities
only.
iv. I/ we will provide KARI with an appropriate quotation for all goods/resources and
then provide a final invoice to KARI attached to the application.
8. APPLICATION CHECKLIST
Please use this check list to ensure you have complied with all of the application requirements.
Applications that are received without all of the relevant information below will not be
assessed;
☐ I have read and understood the application guidelines
☐ The application form is complete
☐ Original Tax Invoices are attached
☐ All requested documentation is attached to this application
☐ I have kept an original copy of the application for my own files
I hereby attest that I have read and understood all of the information contained within this
document (including the terms and conditions) and wish to proceed with the application.
Applicant name: Click here to enter text.
Date:
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