2015 Activity Grant Application for Funding Organisation details (or sponsoring organisation details) Funds are only provided to non-Government organisations and/or not-for-profit organisations. Name and Postal address of the organisation and/or auspice organisation: include ABN ABN: Telephone number: E-mail address: (required for receipt notification) Contact Details of Event Organisers: Name Position Phone Details of person responsible for financial accountability: Name Position Phone Does your organisation hold appropriate insurance? Please ensure that your public liability insurance covers the proposed event. Please specify the type of insurance cover held: Public Liability Insurance Policy Details: (attach copy of current certificate): Policy No: Insurer: Expiry Date: Overview of Activity: This section must be completed in 1,000 words or less. Application due date Friday 22 May 2015 Acquittal due Friday 9 October 2015 Your application will be judged against the following key criteria. Be sure to use these criteria as headings in your proposal. 1. 2. 3. 4. Date of proposed event or activity Location include address of proposed event Description of the proposed activity, include estimated number of attendees CPW theme: explain how the activity has been designed to positively support the Child Protection Week theme and aims – see guidelines for details 5. Promotion: outline how both the activity and Child Protection Week will be promoted, and to whom (eg. brochures, posters, media etc). Proposed Budget - Grants of up to $1000 (inclusive of GST) are available: Please provide banking details for payment processing: BSB: Account Number: Account Name: Please provide itemised breakdown of anticipated costs: Item Amount Total Funding requested $ This document is a Tax Invoice. ACT for Kids (ABN 4705 1964 673) auspice body for the Queensland Child Protection Week Committee Amount: $1000.00 (inclusive GST) subject to funding approval. Application due date Friday 22 May 2015 I/we declare that the information provided here is, to the best of our knowledge, accurate and complete. I/We agree to abide by the conditions of funding laid out in the application form and understand that I/we will be responsible for completing an accountability of expenditure report within one month of the completion of the activity. Signed: ______________________________ Date: ____________________________