City of Wanneroo

Instructions

For enquiries that are of an urgent-nature that require immediate assistance or that relate to animals, parking, ranger assistance or other community safety matters, please call us on (08) 9405 5000

To ensure a timely and professional response, please complete this form with as much detail as possible.

Your personal information collected in this form will help us to complete your request or to improve our services, in accordance with the City's Personal Information Privacy Policy.

Donation Application Form

Name of Organisation or Group (as per corresponding bank account) (Required)

Contact Person (Required)

Position (Required)

Postal Address (Required)

Contact Number (Required)

Email Address (Required)

Is your organisation or group incorporated under the WA Associations Incorporation Act 2015 (Required)

Yes

If yes, please provide Year of Incorporation

Do you have an ABN? (Required)

Yes

If yes, please provide ABN

If no, attach a completed Statement by a Supplier form further below

Is your organisation registered for GST? (Required)

Yes

Basis of Operation (Required)

If Other, please specify

Describe the role of your organisation (Required)

What suburb is your organisation located? (Required)

Number of members/clients (Required)

How many members/clients are residents of the City of Wanneroo? (Required)

Has your organisation applied for and received any funding from the City during this financial year? (Required)

Yes

If yes, what type of funding (Donation, Sponsorship, Community Funding)

Funding amount received (if applicable)

ACTIVITY, EVENT OR PROGRAM DETAILS (A,E,P)

Please choose the type of application (Required)

Name of A,E,P (Required)

Description of A,E,P (Required)

Date of A,E,P (Required)

Location of A,E,P (Required)

Attach Event Notification Form / Evidence City made aware of the Event further below (Required)

If hiring a City facility or park, attach evidence of booking further below. To hire a City of Wanneroo facility, call 9405 5000.

Will the A,E,P be free of charge for City of Wanneroo residents to access? (Required)

Yes

If not, what is the entry/access fee and what is it used for?

Who will benefit from the A.E,P (directly and indirectly)? (Required)

Is this intended as a fund raising or profit making A,E,P? (Required)

Please describe what the donation request from the City will be specifically used for? (Required)

Please indicate how your organisation will acknowledge the City's support (Required)

DONATION SUPPORT PERIOD BUDGET SUMMARY

Cash amount contributed by your organisation for this A,E,P (Required)

In-kind contribution (e.g. $ value of volunteer time) (Required)

Description of in-kind contribution (Required)

Cash amount from other sources for this A,E,P (Required)

Amount requested from City of Wanneroo (Required)

Sum of the total costs above (Required)

Provide any additional information here relating to A,E,P including any web & social media URLs / hyperlinks to A,E,P

Please provide details

Upload Attachments (Event Notification Form, Evidence of Facility Booking if applicable, Statement by a Supplier if applicable) *

Please click below to upload files relating to this submission.

AUTHORISATION

I certify that I am authorised to make this request on behalf of the organisation and certify this funding application was approved by the Board/Management Committee of this organisation. (Required)

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