Silverton Wind Farm Local Community Fund

Organisation Information
Due Diligence
Have any of the Organisation’s Directors, Principals and/or Board Members been served with a bankruptcy notice or directed a company that has been insolvent in the last five years? If so, please provide the details.*
Please attach the organisation’s latest business plan (if applicable).

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About the organisation
Please provide a brief overview of your organisation or community group, identifying the goods and/or services provided to the local community*
What is your organisational goal/mission?*
Formal legal status of the organisation:*

CorporationPartnershipGovernment entityNon-profit organisationSocial enterpriseOther
How does your organisation currently fundraise?*
Does your organisation have public liability insurance?*

YesNo
Has your organisation received funding or support in kind from AGL in the past 12 months?*

YesNo

Description, Amount or in-kind & Date:*

Project or Initiative Details
Name of project / initiative:*
Location (which communities will be involved and how will they benefit from this project / initiative?):*
Description of project / initiative:*
Start Date:*

DayMonthYear
Date
End Date:*

DayMonthYear
Date
Explain in detail how will your organisation use the grant?*

Project / Initiative Key Facts
How many people do you expect will directly benefit from this project / initiative?*
How will you measure success of the program?*
(e.g. number of attendees)
How does your project / initiative align with the AGL values of Bring on tomorrow, Can do. Will do, Be safe. Be supportive?*
What key focus areas does the project / initiative address?*

EducationYouthEnvironmentHealth, safety and wellbeingCommunity infrastructureArts and cultureEconomic developmentSocial welfare
How will funding contribute to this/these areas? *
Outline the identified community need for this initiative:*
Outline any professional advice sought throughout the development of this initiative:*

Breakdown of spend:*

Total budget ($):*
Funding from other sources (outline other groups, organisations or people who will be involved in the program, and briefly describe their involvement or role):*
What is the minimum amount of funding this program can be run with?*
How will AGL be recognised for the support of this program?*

Flyers, brochures, event programsLocal print mediaInvitation to the eventRadio/TVPrinted merchandiseSignageAcknowledgement in speeches/formalitiesOther

Final question
How did you hear about the Camden Community Support Fund?*

NewspaperSocial MediaLocal CouncilLocal MP's OfficeOther
If you selected 'Other' please describe:
e.g. Heard it from a friend

Key Contact