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 must be held during Child Protection Week, 5 - 11 September 2021
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 2021 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 14 May 2021

Acquittal due 5 October 2021
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. Due date 5 October 2021
- I Agree
Signature*
Sign electronically using your mouse/finger
Date*

DD
MM
YYYY
Please note that you cannot edit your application after submission. If you would like to come back and continue your application before submission, please click 'Save and Continue Later'.

Name	Position	Phone

Name	Position	Phone

Activity Grant 2021