EnergyAustralia Community Grants Application Form

As a member of the Illawarra Region, we are committed to making a positive contribution to our local community. This year, we will distribute up to $20,000 in grant funding to a number of local organisations who can address key local issues currently facing our region.

Applications for grants up to $20,000 will be accepted between 22 May and 5pm 23 June 2017.

Please email your completed application form to Tallawarra@energyaustralia.com.au

You may attach further information regarding your proposal if you wish.

Part one: applicant’s details

Organisation:

ABN/ACN:

Address:

Contact name:	Phone:

Email:

Part two: Project Details

Project name and description: Provide an overview of your proposal/project. What outcome are you trying to achieve or issue are you trying to address?

Project Location: What areas/communities does your project impact?

Outcomes: Explain how the project will deliver against the priority areas:

Social inclusion

Education and knowledge acquisition

Part three: Application for Funding

Funding Amount: How much funding are you requesting?

Budget and allocation of funds: What is your total budget for the project? Please provide details of how funds from the grant will be used and include any other sources of funding:

Timeframe: provide a timeline for the project:

Part four: Project Reporting

Evaluation: How will you know the project is successful?

(name of organisation) I acknowledge and agree to the EnergyAustralia Tallawarra Community Grants Guidelines.

Signed for and on behalf of	by its authorised representative:

………………………………………………………………
Signature

………………………………………………………………
Name

………………………………………………………………
Date