Expression of Interest to Receive Support The C, J & B Glennen Charitable Foundation For enquires: Troy Parker, C, J & B Glennen Charitable Foundation, FINDEX, 175 Bromfield Street, Colac Victoria 3250 ABOUT YOUR ORGANISATIONOrganisation Name(Required)Primary contact person(Required)Email(Required) Phone(Required)Organisation status – Are you an incorporated association?(Required) Yes No What is your Registration Number?Are you registered with the Australian Charities & Not-for-profit commission? If yes, what is your Registration Number?Approximately, how many members do you have?What are your annual membership or service fees?YOUR PROJECT LOCATIONAddress of the project site(Required) Street Address Suburb or Town State / Province / Region ZIP / Postal Code Who owns the project site and/or facility (eg Council, private building)?(Required)If your organisation doesn’t own the land/building, what tenure arrangement do you have with the landowner/land manager? Do you lease the land/building or are you a committee formally appointed to manage the site?If your project doesn’t relate to a set site or facility, describe as best you can the locality/town/community you are targeting.PROJECT DETAILS AND INTENDED OUTCOMESProject Title(Required)Briefly describe the project(Required)List the three main outcomes of your project(Required)Who and how many people will benefit from this project?(Required)Who will implement the project (eg group members, contractors, other volunteers, a combination of resources)?(Required)Commencement Date(Required) Completion Date(Required) PROJECT FINANCIALSList the amounts from the funding sources belowYour organisation’s contribution (funds or in-kind)Funds from other organisations (local, state or federal government, local business, other charity organisation, other)Funds requested from the C, J & B Glennen Charitable FoundationTOTAL PROJECT COSTHow did you calculate your project costs? For example, discussions with local contractors, past experience and/or quotes.(Required)Note: If you are proposing to purchase equipment or services greater than $5,000 in value, please submit your quote(s) with this application.Have you applied elsewhere for funding?(Required) Yes No If yes, provide details of what organisations, amount applied for and when you will know if you have been successful.If this application is unsuccessful, will you go ahead with the project?(Required)DOCUMENT UPLOADSYour organisation’s latest annual financial statement(Required)Max. file size: 128 MB. Project detailed information attachment one (if required)Max. file size: 128 MB. Project detailed information attachment two (if required)Max. file size: 128 MB. Quote 1 (if required)Max. file size: 128 MB. Quote 2 (if required)Max. file size: 128 MB. Depending on the nature of your project, an onsite visit or further discussions maybe required to process this application. All funded projects are required to submit a completion report. Are you a robot?
