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Section A: Organisational Details

1.1 Nominated Recipient for Funds (to whom payment will be made)

Name of group, club, school or individual
Position
Contact Person
Postal Address
Telephone
Fax
Email
ABN (if applicable)
Is your Organisation entitled to receive income tax deductible gifts?
(ie Deductible Gift Recipient Status, DGR's)
Yes     No
What is the organisation's mission?
What services/programs does it deliver?
Please provide details on the organisation's executive staff and Board Members

1.2 Partner Organisations (if any)

Partner Organisation 1Partner Organisation 2
Name of School/Agency Name of School/Agency
Position Position
Contact Person Contact Person
Postal Address Postal Address
Telephone Telephone
Fax Fax
Email Email
ABN ABN

Section B: General Project Information

Which of the following categories best applies to the project you wish to be funded? (Please tick one or more)
Public health programs and services, ie projects that would result in the improvement of health, fitness and well being of the community.

Community capacity building projects, ie support for infrastructure projects (bricks and mortar.)

Public education including education scholarships, school buildings and libraries, ie improving education opportunities.

Families, children, and youth initiatives as well as Cultural and arts initiatives, ie enhancement of Art, Cultural and Youth Programs.

Environment Projects

Other (please explain)  
Name of Project
Name of lead agency
Total funds applied for (applications up to and including $5,000 will be considered)
Number of participants expected to benefit from the project
Project aim
Project target group
Is there a specific group that will benefit from this funding?
Reason for targeting this group
Brief outline of your project proposal
Explain why this work needs to be undertaken, include demonstrated evidence for the need for this project.
How will these outcomes make a difference?
How well placed is your organisation to do the work?
If this application is applying for funding for a program that you currently deliver, provide evidence of the outcomes you have achieved to date and the need for the funding
How does/will your project fulfil a social need?
Where will the project operate/be delivered?
How will you publicise the project and its outcomes?
How will the work continue after the current funding period?
Please identify expected outcomes for this project.
How will this project benefit the community?
Expected Outcome(s)
 How it/they will be measured
Proposed date for commencement
Proposed date for completion of the project
What other funding sources have you sought? please list.
Source
 Amount
What type of resources are you, the organisation or partnership committing to the project?
Resource
 Organisation

Section C: Project Budget

Please complete the following budget table for your proposed project

Expenditure

1. Staffing Expenses $
2. Hire of Facilities $
3. Equipment $
4. Operating Expenses $
5. Consumables (ie. Supplies etc) $
6. Other Expenses $ Please specify
7. TOTAL PROJECT COST (Add numbers 1 - 6) $

Other Income

8. Applicant Contribution-Income Provided by Applicants or other Funding Bodies $
9. "In Kind" contribution (labour etc) $
10. Other Income $ Please specify
11. TOTAL PROJECT INCOME (Add numbers 8 - 10) $

Total amount requested from "McKern Steel Foundation (Subtract number 11 from number 7)

Subtract number 11 from number 7 $



Please provide details of any in-kind contributions made by applicants:
eg. volunteers; use of facilities; use of equipment or supplies; transport etc
 Equivalent Expense ($)

Verification and Submit

For any further information, please contact Michael McKern on 03 5449 1201.

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