Not-for-Profit Partnership Program Application Form

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Organisation

Not for profit?

YesNo

Contact Name

Role within organisation

Postal address

Postcode

Email address*

Mobile

Is your organisation registered for GST?

YesNo

Does your organisation have an Australian Business number (ABN)?

YesNo

Tell us about your organisation; how does it operate and how many staff do you have (including volunteers)? (150 words)

How long has your organisation been operating?

Do you have an office based in Geraldton?

YesNo

How does your organisation benefit the community? (150 words)

Who does your organisation impact? Please be specific e.g. We support ~500 young people per year aged 12-25 years in Geraldton through targeted sport activities in the Mid West. (100 words)

Indicate the category that relates best to your organisation? Select an Option

Beyond funding, what in- kind support from MWPA would be most valuable to your project? See out Skills Map on our grants webpage.

Describe how your organisation demonstrates each of MWPA’s corporate values (Accountability, Care, Courage, Collaboration, and Integrity) through your work, culture, or community engagement. (50 words per value, 250 words total)

Does your organisation have any other current sponsors, if so, who are they?

Please outline how you intend to use the partnership funds if your application is successful. Please provide a brief description of your budget below and attach a detailed breakdown to this application via the template provided.(150 Words)

Budget - Year 1

Budget - Year 2

Budget - Year 3

How will your organisation deliver on the required partnership actions outlined in the annual breakdown? Note this includes social media posts, newsletter articles, press etc (150 words)

Actions - Year 1

Actions - Year 2

Actions - Year 3

How will you measure and report on the success of this partnership? Please outline the methods or indicators you’ll use to evaluate outcomes and note whether you plan to share any data or insights once the partnership concludes. (100 words)

Please provide supporting documents including a detailed budget breakdown.

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please tick the box to acknowledge that you understand an acquittal is required at the end of each year of this partnership. The acquittal serves as true and accurate record of spend of all grant monies, and payment will not be made for years 2 and 3 until acquittals have been successfully submitted and received.

I acknowledge that an acquittal is required at the end of each year.

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