Activity Grants – Child Protection Week

Organisation Details (or sponsoring organisation details)
Funds are only provided to non-Government organisations and/or not-for-profit organisations.
Name*
ABN*
Postal Address*
Street Address City State / Province / Region ZIP / Postal Code
Telephone Number*
Email*
Contact Details of Event Organisers:
Event Organiser*
Name Position Phone
Details of Person Responsible for Financial Accountability:
Person Responsible*
Name Position Phone
Public Liability Insurance Policy Details: (attach copy of current certificate):
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:
Policy No*
Insurer*
Expiry Date*

DD
MM
YYYY
Attach Copy of Current Certificate*
Overview of Activity
Your application will be judged against the following key criteria. Refer to the guidelines.
Event Date*

DD
MM
YYYY
Location*
include address of proposed event

Street Address City State / Province / Region ZIP / Postal Code
Identify Event Region:
Event Region*
- Northern Queensland Region
- Central Queensland Region
- Moreton Region
- South East Region
- South West Region

Region	Family support services (Family and child connect catchments)
Northern Queensland	Cairns Cape York/Torres Strait (enquiries currently being managed through Cairns) Townsville Mackay Mt Isa/ Gulf
Central Queensland	Rockhampton/Gladstone/Emerald Maryborough/Bundaberg Kingaroy
Moreton	Sunshine Coast/Gympie Moreton Bay Brisbane North Brisbane South Brisbane South West
South West	Toowoomba Roma Ipswich
South East	Gold Coast Logan Beenleigh/Bayside Browns Plains/Beaudesert

Description of the proposed activity (Maximum 500 words)*
include estimated number of attendees. Please write a statement to explain how your project will reflect the aims and theme of Child Protection Week 2019 in your local community.
Promotion*
outline how both the activity and Child Protection Week will be promoted, and to whom (eg. brochures, posters, media etc).
Please Provide Banking Details for Payment Processing:
BSB*
Account Number*
Account Name*
Please Provide Itemised Breakdown of Anticipated Costs:
Item*
Total Funding requested*
Amount: $1000.00 (inclusive GST) subject to funding approval.

Application due date 19 May 2018

Acquittal due Friday 6 October 2018
Please Tick the Box*
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.
- I Agree
Signature*
Sign electronically using your mouse/finger
Date*

DD
MM
YYYY

Activity Grant 2019