Bald Hills Wind Farm Community Fund Application Form Bald Hills Wind Farm has set up a Community Fund to provide money for projects of social, economic or environmental benefit to the Tarwin Lower, Venus Bay, Walkerville districts. This may include funding for education, sporting/ community groups, environmental or other project works, charities or other needs. $25,000 has been allocated towards the fund for 2015 and will be split into $1000 grants, $500 grants and $250 grants. Applications will be assessed by a committee of community members and successful applicants will be advised. The funding for successful applications will be paid by Bald Hills Wind Farm directly to the suppliers of goods and services, upon presentation of a tax invoice. To apply for a grant please complete the three simple steps on this form and return it to Bald Hills Wind Farm Community Fund. Entries close on 31 July 2015. Return the completed form and any supporting documentation to Bald Hills Wind Farm Community Fund by 31 July 2015. info@baldhillswindfarm.com.au or Bald Hills Wind Farm Community Fund c/o Level 15, 120 Collins Street Melbourne Vic 3000 Applications must be received by 5.00pm on 31 July 2015 Before completing the application form below please ensure you meet the eligibility for funding: Proof of not-for-profit organisation (i.e. incorporation, charter, prospectus, or other evidence) The project will/does provide services within the Tarwin Lower, Venus Bay and Walkerville districts The organisation has been in existence for more than 12 months STEP 1 – YOUR DETAILS What is the project?:___________________________________________________ Total cost of the project $_______________________________________________ Please tick your grant preference: $1000 $500 $250 Other (please provide amount) ________________________________________ Association Name:____________________________________________________ Contact Name: ______________________________________________________ Address: ____________________________________________________________ City: ________ Postcode: __________________ Phone: _____________________________ Fax: ____________________________ STEP 2: Please indicate the category in which funding will be used. Sporting / Community group requirements: (uniforms for sporting groups, boy scouts etc.) Project work: (e.g. building maintenance, sporting facilities, environmental project works) Education: (e.g. education, books for library, computers) Events: (charities, festivals, fundraising) N.B Where the fundraising is for an event or charity held or active in the Tarwin Lower, Venus Bay or Walkerville area, the Bald Hills Community Fund Committee will review applications for funding required for the running of such events, however, it will not contribute directly to the fundraising activities at these events. Other: _________________________________________________________ STEP 3: A detailed description of the proposed use of the funds must be attached in order to be considered. N.B This description must include how the funds will benefit the Tarwin Lower, Venus Bay and/or Walkerville community/ies __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ CHECK LIST (please complete before sending in your application): ❑ Application form completed and signed ❑ Proof of not-for-profit organisation (i.e. incorporation, charter, prospectus, or other evidence) ❑ The organisation has been in existence for more than 12 months ❑ This is the only application to the Bald Hills Wind Farm Community Fund from this organisation this year (If not, please provide the project name/s and grant/s requested for other applications) Other project name/s: ______________________________ Other grant/s requested: $___________ ❑ The organisation has applied for supplementary funding from another grant source for the same project (If yes, please provide the name of the grant source and amount requested) Other grant source name: ____________________________Grant/s requested: $_______________ ❑ The project will/does provide services within the Tarwin Lower, Venus Bay and Walkerville districts ❑ I consent to the Bald Hills Wind Farm using this information and subsequent related information or photography for publicity purposes. ❑If this application is successful, I understand Bald Hills Wind Farm will pay money directly to the supplier of the goods and/ or services upon presentation of a tax invoice Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date: . . . . . . . . . . . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .