Small Community Grants – Application Form - NSW Aboriginal Land Council

DETAILS OF APPLICANT

Name of Recipient (organisation/individual):(Required)

If an organisation, is it an Aboriginal controlled community organisation?(Required)

Has the recipient received a Small Community Grant from NSWALC previously?(Required)

Contact person:(Required)

First Last

Position or title:

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:(Required)

Mobile:(Required)

Email:(Required)

Enter Email Confirm Email

NSW Aboriginal Land Council region:(Required)

Amount requested:

Please also attach supporting documents (for instance flyers for the event, invitations, letters promoting the activity/event etc.)

Supporting documents:

Drop files here or

Max. file size: 128 MB.

Bank Details

(for payment to be made)

Account name:(Required)

BSB:(Required)

Account number:(Required)

DETAILS OF GRANT

Please answer all questions.

1. Please tick the relevant purpose/s for the grant?(Required)

Assisting Aboriginal persons to participate in arts, crafts and sporting activities;

Encouraging participation in and the maintenance of contemporary and traditional cultural life of Aboriginal communities/community;

Promoting understanding of and respect for Aboriginal culture;

Supporting personal development opportunities for Aboriginal people;

Supporting the health and wellbeing of Aboriginal peoples in NSW

2. What will the Small Community Grants be used for?(Required)

Please provide details of the activity, event or purchase including the key dates. Please also attach supporting documents (for instance flyers for the event, invitations, letters promoting the activity/event etc.)

3. For organisations applying for a Small Community Grant please answer the following question:(Required)

How will a Small Community Grants assist in supporting Aboriginal peoples and communities in your region?

4. For individuals applying for a Small Community Grant please answer the following question:(Required)

What impact will receiving this grant have on you, your family and/or your community?

5. Are you a member of a Local Aboriginal Land Council (LALC)?(Required)

If yes, which LALC?

Confidential or Sensitive Information

Please specify what (if any) information contained in this application should be treated as confidential or sensitive and please provide reasons:(Required)

Declaration - I consent to the following(Required)

I have read and understood the Small Community Grants Policy and Procedures including the terms and conditions attached and agree to abide by the provisions therein.

(If applicable) I am authorised to make this application and have delegation to sign on behalf of the organisation.

I declare that the information supplied by me on this form and in its attachments is true, complete and correct.

I understand that my application may be rejected if I provide false or misleading information.

Declaration (continued)(Required)

I will notify NSWALC of any changes to the information provided and any circumstances that may affect this application.

I acknowledge that all decisions pertaining to NSW Aboriginal Land Council Small Community Grants are at the total discretion of the NSW Aboriginal Land Council and I have no right to appeal any decisions made by them.

I have read and agree to the above and the Privacy Notice contained below.

Privacy Notice: By completing this form you may be providing personal and/or health information to NSWALC. The personal and/or health information collected will be used by the New South Wales Aboriginal Land Council (NSWALC) of Level 5, 33 Argyle Street Parramatta, NSW to assess your Application for a Small Community Grant and if you are successful to report on the administration of NSWALC’s Small Community Grant scheme.

The supply of the information is voluntarily and alternatives to providing personal information can be discussed, should you, or anyone whose personal information may be provided, choose not to provide that personal information.

Your personal and/or health information may be disclosed to your NSWALC Councillor, NSWALC team members and third parties for assessment purposes and if successful, your name will be disclosed in NSWALC’s Annual Report which will be made publicly available. NSWALC will use and disclose your personal and/or health information for the purpose for which it was collected, for a directly related purpose, when NSWALC has the appropriate consent to do so, to prevent or lessen a serious and imminent threat to your life or health, or the life or health of another person, or otherwise as required, permitted or authorised by law. Other than as detailed above, NSWALC will not disclose your personal and/or health information without your consent unless it is authorised or required by law.

Any personal and/or health information will be held by NSWALC at NSWALC’s offices and/or on NSWALC’s computer systems or archived at an external facility. You may apply at any time to see what personal and/or health information about you is held by NSWALC and check its accuracy. If any of the information is inaccurate, out-of-date or incorrect, you may apply to NSWALC to have the information corrected.

If you consider that NSWALC has not managed or used your personal and/or health information correctly, you may make a complaint to NSWALC’s Privacy Contact Officer, Manager Governance. You may also make a complaint directly to the NSW Privacy Commissioner and further information can be found on the Information and Privacy Commission website at https://www.ipc.nsw.gov.au/

Please contact us if you have enquiries about the management of your personal and/or health information by contacting the Privacy Contact Officer, Manager Governance on (02) 9689 4444. Please also see NSWALC’s Privacy Management Policy and Privacy Management Plan.

Name:(Required)

Signature(Required)

Date(Required)

Phone

This field is for validation purposes and should be left unchanged.

NSWALC Small Community Grant (SCG) - Application Form

DETAILS OF APPLICANT

Bank Details

DETAILS OF GRANT

Confidential or Sensitive Information