Caroona Coal Project
IMPORTANT NOTE: The Caroona Coal Project Community Fund is structured to
benefit the communities of Gunnedah and Liverpool Plains Shires. Please refer to
the Community Fund and Priority Focus Areas brochures for further details about
this and other funding guidelines prior to completing this application.
LOCAL SPONSORSHIP PROGRAM for Applications between $500 and $5,000
Date of application
Date received (Office use only)
Q1 PREVIOUS FUNDING
Have you previously applied for funding under this program?
If so, when do you last apply?
Was your application successful?
Q2 ORGANISATION & CONTACT PERSON/S DETAILS
Name of organisation
Organisation location address
Organisation postal address
Type of organisation
Private enterprise or for-profit entity
Non-profit entity, including registered
charities
Association
Local Government
Community Council (Indigenous Council)
State Government funded agency
Other – (please specify)
Primary contact person for correspondence - Name and position title
Primary contact person e-mail address
Work phone
Mobile phone
Fax
Secondary contact person for correspondence - Name and position title
Secondary contact person e-mail address
Work phone
Sponsorship Form 500-<5k Version 2
Mobile phone
Fax
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Q3 PROJECT DETAILS
(A) What is the project/activity name?
(B) Summary of proposed project/activity: (250 word limit)
(C) What is the expected outcome/s of the sponsorship? (100 word limit)
(D) With which focus area/s does your project/program best relate?
Education and Training
Environment
Indigenous Development
Enhancing Community Liveability
Health
Other - please specify
Community Development
(E) How does your project/program relate to one or more of the Priority Focus Areas for funding?
(250 word limit)
(F) Where will the project/activity operate from? i.e. the location
Q4 BENEFICIARIES
(A) Who are the principal beneficiaries or target group/s?
(B) How many people will directly benefit by the project/activity?
(C) Which geographic area will benefit from the project/activity? Please specify.
(D) Describe the impact/s the project will have on the community or target group.
Sponsorship Form $500<5k Version 2
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Q5 PROJECT MANAGEMENT
(A) How will the project/activity be managed and by whom? (include financial management details)
(B) What is the timing for implementation of the project/activity?
(C) When is the requested sponsorship required?
Q6 EVALUATION AND REPORTING
Please provide measurements that will be used to determine the success of the project.
Q7 FINANCIAL MANAGEMENT
(A) What is the total amount of funding required for your
project/activity to proceed. (This figure should match the total
budget requirements in Q8)
(B) How much funding is being sought from the Caroona Coal
Project Sponsorship Program in total?
(C) How much is being sought in this financial year?
(D) OTHER FUND CONTRIBUTORS: Please list below the names
of any other sources of funding requested including:
 Government: Local, State and Federal
 Other funding providers
 Or other organisations
(Please add more lines if required)
$
$
$
How much
funding has
been
requested
from other
funding
sources?
$
$
$
$
$
$
(E) Total amount requested from other funding providers.
$
(F) Total amount confirmed from other funding providers.
$
(G) Over what period is sponsorship support being sought?
From
/ /
(H) How specifically will you use the proposed cash/in kind support?
Indicate if
funding is
confirmed or
the date that
confirmation
of the funding
proposal/s
success is
expected.
To
/ /
(I) What contribution will your own organisation or community/volunteers make towards the
project/activity? E.g. volunteers’ time or funds already raised.
(J)Tax deductibility status: While it is not essential to have tax
deductibility status it may be of advantage. Has your organisation
been granted Deductible Gift Recipient (DGR) status? If your
organisation is a DGR, please attach evidence in the form of a
letter from the Australian Taxation Office.
Sponsorship Form $500<5k Version 2
DGR Status
Yes
No
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Q8 PROJECT BUDGET
Itemised Budget Item: e.g. event location hire, catering etc. (please add more lines if required)
$
$
$
$
$
Total Budget Requirements
$
Q9 SPONSORSHIP ACKNOWLEDGEMENT
How will BHP Billiton Caroona Coal Project be acknowledged for the contribution? Below are some
suggestions. Please indicate ‘yes’ in any of the boxes alongside if they are appropriate for your
project/activity.
Use of Logo/brand name in advertisements or press releases
Branding banner displays at the site (indoor or outdoor)
Caroona Coal Project staff representative participation in the event/program such
as making presentations or volunteer work
Logo/brand name PowerPoint projection display (indoors event)
Acknowledgement of sponsorship throughout the event/program
Acknowledgement photos or certificate for office display
Event/program photos for inclusion in the Caroona Coal Project newsletter or
promotion of the fund
Naming rights of an event or program
If you answered yes to naming rights please elaborate.
Any other marketing or promotion that your project/activity may provide. (Please specify)
Q10 MARKETING AND PROMOTION OF THE PROJECT/ACTIVITY
Do you have a marketing plan to promote your project/activity? Detail marketing activities or attach
a marketing plan
Who is your promotional target audience?
Payment Details
Should your application be successful; the Caroona Coal Project will require additional
information for payment/s. To streamline the payment process, please provide a separate letter
(on a letterhead) that states; the name, location and postal address of your organisation, A.B.N.
and/or A.C.N. (if applicable), the primary contact person’s name and contact details including
phone, fax and email address, and banking details of the organisation including the name of the
Financial Institution, Account Name, BSB number and Account Name.
Sponsorship Form $500<5k Version 2
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Support materials
Please note that if support materials such as videos, sound cassettes, photos, or other
documents are sent that we cannot guarantee their safe return.
Send your application to:
Andrew Garratt
Head of Community Relations and External Affairs
BHP Billiton Coal Mines Australia Pty. Ltd.
Caroona Coal Project
Cnr Hawker and Nowland Sts,
Quirindi NSW 2343
Mobile
Email
0467 759 929
andrew.garratt@bhpbilliton.com
Local Sponsorship between $500 and $5,000 will be assessed bimonthly. Applications should
be received at least three months prior to commencement of the project to be given
consideration. In some instances it may be necessary to obtain additional information from
applicants to assist in the assessment.
Declaration
I the undersigned declare the information provided to be a correct and honest description of our
organisation and/or events and the support needed.
Signed:
……………………………………………
Name of Signatory:
……………………………………………
Date:
……………………………………………
Please note: Completion and lodgement of this application form does not guarantee support from
the BHP Billiton Caroona Coal Project Community Fund.
Sponsorship Form $500<5k Version 2
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