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CBT Application Form

Project Name:

Organisation:

Grant Value:

Legal Entity:

Trading Name:

Layout:

ACN:

ABN:

Are you currently registered for Goods and Services Tax (GST)?:

Address:

Phone:

Email:

Name:

Position:

Phone:

Email:

Name:

Position:

Phone:

Email:

Please confirm that the organisation is eligible to apply for a grant by ticking the relevant box below.:

Provide a brief overview of your organisation including its purpose and operations.:

Is a Business Plan or Feasibility Study available in relation to this project?:

If yes, please include a copy with your application:

Project Name:

Provide an overview description of the project including its current status.:

How does this project coordinate or support your organisation’s other initiatives?:

What are the key outcomes this project will achieve? (Please be as specific as possible):

Who will directly benefit from this project? (Include numbers of people if known):

How many local people will be employed with this project?:

How will this project assist the Borroloola community to achieve its vision as described in the Project Funding Guidelines?:

Of the Trust focus areas below, to which one category does your project best relate?:

How will the community be involved in or contribute to the project?:

Does the organisation have the support of key community stakeholders to implement this project?:

File Upload:

Does this funding include the purchase of assets?:

If yes, do you acknowledge the CBT’s requirements regarding the resale of funded assets? Please refer to the updated Funding Application Guidelines.:

List the members of your organisation’s executive management and Board and provide evidence of their support for the project.:

How will the project and its finances be managed?:

Provide details of the implementation schedule for this project including the start date.:

Please nominate 3-4 key performance indicators or targeted outcomes that will determine the success of the program.:

Please indicate the length of your project. These periods will be included in Funding Agreements for projects approved by the Trust in line with the stated reporting periods in the Guidelines.:

File Upload:

Layout:

What is the total budget for the project?:

What is the total funding being sought (GST exclusive) from the MRM Community Benefits Trust?:

How much equity is your organisation putting into the project?:

What is the anticipated commencement date?:

How much is sought from other sources of funding?*:

How much funding is for this financial year (year ending 30 June)?:

What is the period the funding is being sought for?:

*Is funding available through any other sources e.g. Territory, Federal, Philanthropic trusts or any other sources?:

Please indicate what other sources have been considered and the status of these approaches. Please specify the program name, source and level of funding.:

If your organisation is registered, required to be registered or become registered for GST, do you agree to issue valid tax invoices prior to payments being made by the Trust?:

Will the project require funding support in subsequent years?:

Please indicate how the organisation will meet resulting recurrent commitments, aside of any grant support from the Trust.:

How will the MRM Community Benefits Trust be recognised for its contribution to your project?:

Layout (copy):

Full Name of Accountable Officer 1:

Signature of Accountable Officer 1:

Email of Accountable Officer 1:

Position in organisation - Accountable Officer 1:

Date:

Layout (copy) (copy):

Full Name of Accountable Officer 2:

Email of Accountable Officer 2:

Position in organisation - Accountable Officer 2:

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October 23, 2025 2:51 pm ACST

CBT Application Form Uploaded by Marilyn Trad - [email protected] IP 180.94.233.43