Application for Medium Grants
Community Development Match Fund

 
 
Required fields are marked * (Please note all required fields must be complete in order for your application to be submitted. If the field is not relevant to you simply type N/A)
 
Application Details
 
Name of Group *  
 
Contact Name *  
 
Postal Address *  
 
Phone (day): *  
 
Phone (mobile): *  
 
Email: *  
 
Website:
 
Legal Status
 
Are you a registered charity? *
 
 
 
Are you an incorporated society?
 
 
 
Are you a trust?
 
 
 
If you are none of the above you will need to find a registered charity, incorporated society or trust to administer funds on your behalf. Please give details of this umbrella body.
 
Contact Person
 
Organisation Name
 
Postal Address
 
Phone (day):
 
Phone (mobile):
 
Email:
 
I confirm that I am a representative of the organisation and am aware of this application: *
 
 
Finance Details
 
Is your organisation GST registered?
 
 
 
Bank Account Number: *  
 
Please attach a copy of your bank deposit slip:
 
Word or PDF format is preferred - we may be unable to open other formats.
 
Please attach a copy of your most recent financial statement:
 
Word or PDF format is preferred - we may be unable to open other formats.
 
Please tell us about your group/organisation
 
What do you do? *  
 

 
 
Area of benefit (geographical, sector, etc)? *  
 

 
 
Who do you work with? *  
 

 
 
Please tell us about your project *  
 

 
 
When will your project take place: *  
 
Where will your project take place: *  
 
Who will be involved and what will the benefits be? *  
 

 
 
What do you hope to achieve as a result of the project? *  
 

 
 
What are your project costs and contributions?

List the costs you would like us to fund (items and $ value) *
 
 

 
 
List what you are contributing from your community (items and $ value) *
 

 
 
Is there any other information you would like to share that would support your application?  
 

 
I declare that the above information supplied here
on behalf of my organisation is correct: *

 
 
 
 
 
 

Who can apply?

How Much Can I Apply For - Medium grants round is open. Apply for up to $10,000 until 31 November 2016

How to apply - A few steps to get your project off the ground

Funded projects