Koroit & District Community Fund - Expression of Interest form
Organisation Name:
ABN:
Organisation address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Person
First Name
Last Name
Position (in organisation)
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Is your organisation a deductible gift recipient?
Auspice Organisation (if required)
Auspice ABN:
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Grant amount
Amount requested?
If amount is more than $10,000 would part funding still be useful?
What is the total cost of the project/activity?
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Project details
Title of project
How many people will directly participate/benefit from this project?
Who is the primary cohort that will participate/benefit from this project?
Have you received support from other community stakeholders for your project/activity?
What is the anticipated commencement of the project/activity?
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Month
-
Day
Year
Date
What is the anticipated end date of the project/activity?
-
Month
-
Day
Year
Date
Provide a detailed description of the project/activity and the outcome you want to achieve. Max 300 words
What type of activity are you wanting funded?
Please Select
- Delivering activities, programs and services
- Training and support for volunteers
- Purchasing equipment and materials
- Community infrastructure
- Community education, environment and health projects
- Community based music, theatre, arts or cultural activities
- Community resource development
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Please review all fields then press submit.
Submit
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