Community Sponsorship Application

APPLICATION 2024-25
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Applicant Details

Organisation Name *

ABN *

GST Registered?

Postal Address *

Suburb *

State *

Postcode *

Phone Number *

Email Address *

Contact Person *

Mobile Phone Number *

Auspice Details (if applicable)

Auspice Organisation Name

Auspice Organisation Address

Auspice Organisation Phone

Auspice Organisation Email

Auspice ABN

Registered for GST?

Details of Proposed Project, Activity or Event

Project Name *

Start Date *

End Date *

Description of project, activity or event *

Location/s of project *

Estimated number of participants in project activities *

Acquittal/Outcome Report (due no later than 8 weeks after the project end date)

Project Benefits

Demonstrated benefit to Cook Shire (please refer to Community Grants and Support Program guidelines) *

Select which strategy/strategies from Councils Ten Year Community Plan your proposal identifies with *

Explain how your project relates to the above identified strategy: *

Provide details of the consultation and partnerships created through progressing the project: *

Provide details of previous experience and your ability to successfully deliver the project: *

Steps you have taken to address issues of workplace and public health and safety (COVID 19, health and safety, public liability insurance etc) *

Project Budget

Provide a project budget -

Round all amounts to whole dollars;
If you have applied for funding from other grants for the project, when listing these sources in Other funding, please note if it has already been approved.
If you are NOT GST registered, your organisation will be paid exclusive of GST

Expenditure and income should be shown EXCLUSIVE of GST and totals for each should be the same (ie if cost is $5,000 ependiture should be $5,000). An example of how to calculate the project budget is included in the Community Grants and Support Program guidelines.

Income

Expenditure

Funding requested

Purchases

Applicant contribution

Contractors

Fundraising, donations, in-kind

Production/Promotional costs

Earned income (ticket sales)

Administration, salaries, fees, allowances

Total income

Total expenditure

List any funding you or your organisation has received in the past 18 months (Cook Shire Council and other)

Funding #1

Date funding received

Amount

Purpose of funding

Acquittal complete(if no provide details)

Funding #2

Date funding received

Amount

Purpose of funding

Acquittal complete(if no provide details)

KEY TERMS & CONDITIONS

Please read each statement below and sign to confirm your acknowledgement and agreement of these terms:

I certify that I have the appropriate delegation, as authorised by the applicant, to prepare and submit this application on behalf of the applicant.
I have read the guidelines relating to Cook Shire Council’s Communtiy Sponsorship Program and certify to the best of my knowledge the information provided in this form is correct and disclose full and accurate information of expenditure and activities proposed.
I understand that approval of the grant is subject to mutual agreement between Cook Shire Council and the applicant.
I agree to ensure all necessary approvals/permits are obtained prior to the project, program or event taking place.
I agree to provide Cook Shire Council with any additional information required to assess this application.
I will provide appropriate insurance to cover the proposed project and abide by all relevant health and safety standards.
I understand that Cook Shire Council does not accept any liability or responsibility for the proposal in the application.
I understand that if Cook Shire Council approves the application, I will be required to accept the conditions of the grant in accordance with Cook Shire Council requirements.
I agree that if funded, I will supply an acquittal form (including a copy of all required receipts and other requested documentation) within eight (8) weeks of completion of the project, activity or event.
I will acknowledge the support of Cook Shire Council in all relevant promotional and printed material and invite at least one Cook Shire Councillor to any events, functions or launches as appropriate.
I acknowledge that Cook Shire Council may publish the details of the application and subsequent project, activity or event, in promotional material or by way of municipal and/or legislative requirements.

SIGNATURE

Signature *

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Date *

Name *

Organisation Position *

Auspicing Agreement (if applicable)

Please read each statement below and sign to confirm your acknowledgement and agreement of these terms:

I/my organisation agree/s to administer the grant that may be offered to the applicant on their behalf.
I understand that both the applicant and auspicing individual or organisation are considered responsible for ensuring the acquittal of grants and that both could be deemed ineligible to place further applications to Cook Shire Council until all grants have been satisfactorily acquitted.
I have read the guidelines relating to Cook Shire Councils Community Grants and Support Program and certify to the best of my knowledge the information provided in this form is correct and disclose full and accurate information of expenditure and activities proposed.
I certify that I have the appropriate delegation, as authorised by the auspice body.

Auspice Signature

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Date

Auspice Name

Auspice Organisation Position

Upload supporting documentation *

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Privacy Collection Notice

Cook Shire Council is collecting your name, residential address and telephone number in accordance with the Local Government Act 2009 in order to process your application. The information will only be accessed by employees and/or Councillors of Cook Shire Council for Council business related activities only. Your information will not be given to any other person or agency unless you have given us permission or we are required by law.

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