Project Funding Application Form 2

Project Funding
Application Form

The McArthur River Mine Community Benefits Trust supports the social and economic development of the Gulf region.

This form can be used to apply for grant funding for programs or projects to be implemented for the benefit of this regional community. Please refer to the Project Funding Guidelines in preparing your application.

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Project Name

Organisation

Grant value

ORGANISATION DETAILS

The organisation is the body applying for the grant and undertaking the proposed project or activity.

Legal Entity (Enter the exact name of the incorporated organisation.)

Trading Name

ACN

ABN

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

Yes

Postal Address

Phone

Facsimile

Email

1. CONTACT PERSON DETAILS

For enquiries regarding the application

Name

Position

Phone

Facsimile

Email

2. ACCOUNTABLE PERSON DETAILS

Name

Position

Phone

Facsimile

Email

3. ELIGIBILITY STATUS OF INCORPORATED ORGANISATION

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

Incorporated under the Associations Act 2003 (NT)

Incorporated with not-for-profit objectives under the Corporations Act 2001 (Cth)

Incorporated under the Co-operatives (National Uniform Legislation) Act 2015 (NT)

Incorporated under the Aboriginal Councils and Associations Act 1976 (Cth)

An organisation with not-for-profit objectives incorporated by an Act of Parliament and which is approved by the Treasurer of the Northern Territory or Commonwealth of Australia.

Other

(please specify)

4. ORGANISATIONAL CAPACITY

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

Detail your organisation’s experience in successfully undertaking projects including:
• Previous project/program delivery
• Working with strategic partnerships
• Reporting, management and technical capacity.

Is a Business Plan or Feasibility Study available in relation to this project? (Please include a copy with your application)

Yes

5. PROJECT DETAILS

Project Name

Project Overview

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?
(Please include number of people to be employed, type of employment [fulltime, part-time, casual, contract] and period of employment.)

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? (Please note if consultation has already been conducted within the gulf regional community in support of your project.)

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

Yes

Please provide proof of this support for relevant projects:
• Local Elders support for Aboriginal culture, arts and/or storytelling projects
• School Council support (in writing) for education, sport and young people’s programs
• Support (in writing) from Gulf Youth and Community Service – for young people’s programs

If the project is a construction or development project, please provide:
• proof of land tenure or permission from landowners
• all necessary development approvals to undertake the project

If the project is a publication, please refer to the CBT Publication Guidelines.

Does this funding include the purchase of assets?

Yes

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

Yes

6. PROJECT MANAGEMENT

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.

7. EVALUATION AND REPORTING

Please nominate 3-4 key performance indicators or targeted outcomes that will determine the success of the program. (e.g. participation in sport in Borroloola increases by 5% by 2025)

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.)

Project < 12 months duration

Project > 12 months duration

8. FINANCIAL MANAGEMENT

Please attach as supporting documentation:
• information about your organisation’s financial status
• a specific budget for this project including projection of revenue from all sources and expenditure.

Please note: Grants are expressed in GST exclusive terms.
For more information on the Trust’s treatment of GST, please refer to the Project Funding Guidelines.

Budget summary

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?

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?

What is the anticipated commencement date?

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

Yes

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?

Yes

N/A

Recurrent implications of project

Will the project require funding support in subsequent years?

Yes

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

NOTE: Where alternative funding has not been considered, Trust’s Project Officer may assist in identifying opportunities.

9. PROJECT PROMOTION

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

10. CERTIFICATION

This application should be signed by the Accountable Officer named in Question 3 and by another office bearer in the incorporated organisation, e.g. Secretary or Treasurer.

We certify:
• The information given in this application is true and correct and that all the conditions of the grant will be complied with should support be approved.
• The application is consistent with the aims and objectives of the incorporated body as set out in its Constitution.
• There will be appropriate insurance coverage for the project.
• Reporting requirements of the Trust will be met.

We authorise McArthur River Mine Community Benefits Limited to confirm details of information provided in this application form with relevant government department and/or non-government sources. We understand these inquiries would be for the sole purpose of assessing the eligibility of a project to be funded by McArthur River Mine Community Benefits Limited.

11. Submit

For further information, please contact the Trust Project Officers at the email/phone number provided below.

Project Officer
Plan C
Jim Gleeson
0422 794 072
email: [email protected]

Checklist – I have attached the following:

Copy of Incorporation document

Information on organisation’s financial status

Completed Project Funding Application

Completed Project Budget

Other:

(Please specify)