Move It NQ program application

LGA *
Contact information *

First Name Last Name
Email *
example@example.com
Program information
Is this application for a new program or a program extension? *
Program location/s
Provide a brief description of the proposed plan *
Please include: Type of activities, identified contractors/ organisations, Program objectives
Main target demographic (tick all that apply) *

General population Women Men Children/ Youth Elderly Indigenous Families
Provide supporting evidence for the proposed program *
Examples include: Demographic/ statistical data, previous program data, community consultation to support need for program.
Promotional strategy *
Budget

Cost ($)

Brief description of costs

Program Delivery costs

Promotion

Equipment

Other (please specify)

Funding *

Funding amount ($)

Move It NQ funding request

LGA financial funding

LGA in-kind support (est. $)

Other funding source (please specific below)

Frequency of program *

Frequency

Sessions per day

Sessions per Week

Length of program (weeks)

Any additional information
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Program information