Expression of interest form
Date conversion 04.06.2018 Size 13.81 Kb.
OF INTEREST FORM Who is eligible to apply for a grant?
The June Canavan Foundation has been established as a Private Ancillary Fund, which means we can distribute money to organisations that are endorsed by the Australian Taxation Office (ATO) as having Tax Concession Charity status and are Item 1 Deductible Gift Recipients (DGR).
You are eligible to apply for a grant if your organisation has DGR status and your proposal is aligned with one of the four focus areas outlined in the June Canavan Foundation Giving Framework.
REGISTERED BUSINESS NAME:
AUSTRALIAN BUSINESS NUMBER (ABN):
SUBURB/TOWN: STATE: POSTCODE:
HEAD OF ORGANISATION (CEO or equivalent)
FOR EXPRESSION OF INTEREST
DEDUCTIBLE GIFT RECIPIENT: Yes No
TAX CONCESSION CHARITY: Yes No
Please attach proof of DGR
status to this application
BRIEF DESCRIPTION OF ORGANISATION (100 words)
PROJECT START DATE: PROJECT END DATE:
AMOUNT REQUESTED: TOTAL PROJECT COST:
FOCUS AREA (please refer to the June Canavan Foundation Giving Framework and indicate which focus area/s your project best aligns with)
Health Yes No
Education Yes No
Sport Yes No
Conservation Yes No
BRIEF PROJECT DESCRIPTION: (A short summary of your project) (100 words)
In completing this application form I acknowledge that I have read the June Canavan Foundation Funding Guidelines and June Canavan Foundation Giving Framework.
I declare that the information provided in this application
is true and correct, and that I am authorised to submit this application on behalf of __________________________
Signature: _____________________________________ Date: _______________
Please email this form together with proof of DGR Status to email@example.com
June Canavan Foundation EOI form v2: JS/Board: 12/12/12
The database is protected by copyright ©dentisty.org 2016