Shire of Capel 2025-2026 Community Budget Submissions

SUBMISSION DEADLINE – 4.30 pm Monday 3 February 2025

should you wish to apply please contact the Shire’s Manager Community Development and Safety, Jeremy O’Neill at 09727 0222 or email jeremy.oneill@capel.wa.gov.au to discuss a potential application.

Please return the completed application form and any accompanying documentation to the above email address by the submission deadline – 4.30 pm Monday 3 February 2025

Introduction

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Project Summary

Community Group Applicant*

Contact Name*

Phone Number*

Email Address*

Amount Requested*

Total Project Cost*

Contact Details

Community Group Name*

Contact Person*

Position Held*

Postal Address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Financial Information

Does your organisation have an ABN?*

YesNo

ABN Number

Is your organisation registered for GST?*

YesNo

GST registration Date

Bank Account Name*

Bank & Branch Name*

BSB*

Account Number*

Is your organisation Not-for-Profit?*

YesNo

Please attach a copy of your Certificate of Incorporation

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Project/Submission Description

Provide a description of your project/submission.*

Provide details of who will benefit from your budget submission?*

Are you working with any other local community groups, businesses or service providers regarding this submission? If yes, provide details.*

Proposed Budget- INCOME (inc. GST)

Details of funding sourced from other organisations (e.g. private business, sponsorship, fundraising, donations)

Shire Contribution Requested*

Community Group Cash Contribution*

Community Group In-Kind Contribution (volunteer labour)*

Other Funding i.e. Sponsorship (please attach documentation)

Documentation

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

TOTAL PROJECT INCOME/FUNDING*

Expenses

Amount $

Expenses

Amount $

Expenses

Amount $

Expenses

Amount $

Expenses

Amount $

Expenses

Amount $

TOTAL EXPENDITURE

Authorisation

The authorised person signing this application should be an executive member, i.e.
president, vice-president, secretary, treasurer or the like.

Application Checklist

Please ensure you attach the following to your application (if applicable):

1. Quotes from suppliers
2. Copy of your Certificate of Incorporation
3. Copy of Current Statement of Financial Position
4. Details of other funding i.e. sponsorship

Authorised Person Full Name*

Position Held*

I am authorised to submit this application on behalf of the organisation*

YesNo

Signature*

Date*

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