Community, sporting and educational groups wishing to apply for financial assistance from Moree Plains Shire Council for events, functions and sponsorship are required to complete and submit a Public Donations Application Form to enable the application to be considered.

Council will consider eligible applications for financial assistance at its first meeting in each financial quarter except in the first quarter of each calendar year, when it may be considered at the first or second meeting of Council.

If you have any questions please email us at business@mpsc.nsw.gov.au

Please note that if you require further space to explain your responses, please provide additional attachments.

Part A: Applicant Details

Name of Organisation *

Address *

ABN

GST Registered *

YesNo

Contact Person *

Contact Phone Number *

Email Address *

Primary activities undertaken by your group / organisation *500 characters max

Not-for-profit community based organisation *

YesNo

Is the group / organisation incorporated *

YesNo

Incorporation registration number of the organisation:

Is the group auspiced by an incorporated association?

YesNo

Name and address of auspice organisation managing the project

Part B: Previous Financial Assistance

Has your group / organisation applied for financial assistance from MPSC in the past? *

YesNo (go to Part C: Project Details)

If yes, was your application successful?

YesNo (please provide details below)

If no, explain why500 characters max

If your application was successful, please specify the type of funding received500 characters max

How much did you receive?

Date funding received

As required under the Public Donations Policy, did your group provide a finalisation report in relation to that funding?

YesNo

Part C: Project Details

Name of Project / Activity / Event / Function ("project") *

Purpose of project *500 characters max

Date of project *

Total cost of project *

Financial assistance requested (max $3000) *

Applicant requests full funding only (ie. activity would not happen with partial funding) *

YesNo

Has funding from other sources been sought? *

YesNo

If yes, please detail efforts made and results (if applicable)

Location of project *

Is it based in the Moree Plains Shire or, if located outside the Moree Plains Shire, does it provide a service that primarily impacts upon residents of the Moree Plains Shire? (evidence of this may be required) *1000 characters max

Please provide a brief description of the project. Tell us what you are going to do and who is involved. *1000 characters max

Project Objectives: Please detail what your objectives are for the project and how these will be met. *1000 characters max

How will the project be evaluated? *1000 characters max

Part D: Community Strategic Plan

10 Year Community Strategic Plan for Moree Plains Shire Council. Click here to view.

Tick box(es) as applicable. Please identify which strategies from our 10 year Community Plan your Project relates to:

Desirable, Cohesive Community: (more than one option can be selected)

C1: Our Shire is a lifestyle and tourism destinationC2: Our community recognises, respects and is inclusive of all of its membersC3: Our community is safe, healthy and happy

Vibrant regional economy: (more than one option can be selected)

E1: Our Shire has a strong, sustainable and diverse economy that leverages our prosperous agriculture sectorE2: Our Shire is connected to the worldE3: Our Shire has a growing population and a skilled workforce

Environmentally sustainable Shire: (more than one option can be selected)

S1: Our community respects and takes care of our natural environmentS2: Our community is resilient

Transformational leadership: (more than one option can be selected)

L1: Our Council is an example of best practice in local governmentL2: Our community is informed, engaged and heardL3: Our community leaders are active, collaborative, and work together to address community issues

Score

Part E: Further Information

Applicant (please select the most relevant category)

Community organisationSporting groupSchool or Kindy

Is this sponsorship ?

First time sponsorshipPrevious sponsorship

Is this sponsorship for ?

Ongoing annual event"One off" eventMinimum contract period

Is this sponsorship for a:

Large donation (over $1000)Small donation (up to $1000)

Does this sponsorship? (more than one option can be selected)

Propose Council match other sponsorship ($ for $)Relate to an event where fees will not be charged

Is this sponsorship supported by: (more than one option can be selected)

In-kind contribution by organisation (at least 25% of the value of the project)Financial contribution or other sponsorship by organisation? (at least 25% of the value of the project)

Supporting the Disability Inclusion Action Plan? (more than one option can be selected)

Provides for, and will promote, disability accessProvides for inclusive activities for the disabled community

How will Moree Plains Shire Council be acknowledged, for example through the use of Council's logo ? (more than one option can be selected)

Sponsorship Calculation

Part F: Budget Details

Sources of Funds / Income: (other grants, sponsorship, fundraising, in-kind support with explanation, Council financial assistance, other income)

Sources of Expenditure: (promotion and publicity, hire fees, equipment and materials, insurance, other expenditure)

Part G: Supporting Documentation

Attach a copy of the Organisation's last audited financial statement or a statement of income and expenditure over the past 12 months.

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Attach a copy of the Organisation's most recent Annual Report.

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Attach a copy of the Organisation's constitution or statement of aims and objectives if a new applicant, or where these details have changed since a previous application.

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Attach a copy of the Organisation's current liability insurance policy, ie certificate of currency (if applicable).

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Attach a copy of notification of the Organisation's ABN and GST registration (if applicable) from the ATO.

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Attach all other relevant information e.g. quotes.

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Attach any other information as noted in this application form.

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Part H: Certification

I certify, to the best of my knowledge, the statements in this application form are true. I have read and I understand the Moree Plains Shire Council Public Donations Policy. I acknowledge that Moree Plains Shire Council cannot guarantee funding for any application and cannot guarantee funding to the full amount requested by any organisation.

I have been authorised by this Organisation to submit this application. *

YesNo

Full Name *

Signature *

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Date *

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