Eligibility conﬁrmation

2021 Community Shade Grants Program Round 6Application form - 2021 Community Shade Grants Round 6Application C6-0026 From The Scout Association of Australia Victorian BranchForm Submitted 5 Aug 2021, 12:22pm AEST

Eligibility confirmation

* indicates a required field

Eligibility

You must confirm that your organisation and project meet all of the following mandatoryeligibility criteria or you will not be able to submit your application.If you do not fulfill the eligibility criteria detailed below, please DO NOT continue thisapplication.

Your organisation is not-for-profit and registered as either an incorporatedassociation, company limited by guarantee, non-trading/non-distributing co-operative, Indigenous corporation or local government entity. *◉ True ○ FalseA peak body/auspice with an ABN overseeing smaller organisations with no ABN may apply onyourbehalf. The auspice making the application would be required to accept responsibility for thedelivery of the project if the application is successful.

Your organisation holds an Australian Business Number (ABN) that preferablylinks to the organisation's name and/or trading or business name. *◉ True ○ FalseA peak body/auspice with an ABN overseeing smaller organisations with no ABN may apply on yourbehalf. The auspice making the application would be required to accept responsibility for the deliveryof the project if the application is successful.

The project does not require an ongoing commitment of funds from the ShadeGrants Program *◉ True ○ FalseShade development works that have already commenced, or are completed, are not eligible forfunding under the Community Shade Grants Program.

The project is not considered routine/cyclical maintenance works *◉ True ○ False

Your organisation has support/approval from other organisations who sharefacilities or grounds *◉ True ○ False ○ Not applicable*If your organisation, does not share facilities or grounds, please select 'Not applicable'

Your organisation will seek support/approval from the landowner for projects thatpermanently impact property *◉ True ○ False ○ Not applicable*If this is not applicable to your organisation, please select 'Not applicable'. Landowners can includeState Government and Council-owned land.

Above statements must be true to proceed with theapplication

The above statements must all be true (or not applicable) in order to proceedwith the application.

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Your organisation details* indicates a required field

Details of organisation to be funded

Legal name of organisation *The Scout Association of Australia Victorian Branch

Trading name (if different)Scout Group

Does your organisation have an existing Service agreement with the Victorian Department of Health? *

○ Yes ◉ No

Street address of organisation *Hall address Must be an Australian post code

Postal address of organisation *152 Forster Rd, Mount Waverley VIC 3149 Address Line 1, Suburb/Town, State/Province, and Postcode are required. Country must be Australia

Local government area *Scouts Groups LGA

Organisation web address *https://scoutsvictoria.com.au/ or Group web address

Must be a URL

Type of organisation *○ Community group○ Sports club◉ Scouts and guide group○ Local council○ Kindergarten○ Early childhood education and care services○ Other:

Select the Account Type that matches your organisation *◉ Private Non Profit○ Government - Local○ Government - State

Details of Auspice organisation (if applicable)

Please only complete this section if you have an auspice organisation

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https://scoutsvictoria.com.au/


A peak body (auspice) with an ABN, may oversee smaller organisations with no ABN. Theauspice is required to accept responsibility for the delivery of the project if the application issuccessful.

Auspice Organisation (if applicable)The Scout Association of Australia, Victoria Branch

Does the Auspice have an existing Service agreement with the VictorianDepartment of Health?○ Yes ◉ No

Auspice Street Address152 Forster Rd Mount Waverley VIC 3149 Australia

Auspice Postal Address

Primary contact for correspondence

This person is the main point of contact for the project and is responsible for submitting thisapplication. The Primary contact is also responsible for:

• Being the principal contact for correspondence• Typically, the authorised signatory who is responsible for signing the service agreement• Disseminating information to your organisation• Overall project management, including budget oversight, risk management andsubmission of acquittal.

Primary contact *Group Leader/Group Representative name

Primary contact Position Title in Organisation * Group Leader/Group Representative position title

Primary contact telephone *Group contact numberMust be an Australian phone number.Must contain area code.

Primary contact mobile number *Group mobile numberMust be an Australian phone number.This may be the same number as provided above under telephone

Primary contact email *Group email addressMust be an email address.Must not be a generic email

Primary contact fax number *Group fax numberRespond 'None' if you do not have a fax number

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Authorised signatory for Service Agreement

An authorised signatory is the person responsible for signing the service agreement.This would typically be a person with suitable financial delegation, such as a president ormanager.If the primary contact is not the Authorised signatory, please select 'No' and provideadditional contact details.

Is the primary contact also the Authorised signatory for the Service Agreement? *○ Yes ◉ No

Authorised signatory for Service Agreement

Please nominate an authorised signatory for the organisation who would be responsiblefor signing the service agreement. This would typically be a person with suitable financialdelegation, such as a president or manager. If your organisation is being auspiced theauthorised signatory needs to be from the auspicing organisation.

Authorised signatory name *Mr Jon McGregor

Authorised signatory position *Executive Manager and General Secretary

Authorised signatory Mobile Phone Number *0407 183 012 Must be an Australian phone number.

Authorised signatory Primary Email *[email protected] Must be an email address.

Secondary contact for correspondence

The Secondary contact is the person that will be contacted, should the primary contact, beunavailable.

Secondary contact *Ms Narelle Bray

Secondary contact Position Title *Grants Coordinator

Secondary contact telephone *+61 410 683 420Must be an Australian phone number.Must contain area code.

Secondary contact email *[email protected] Must be an email address.

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Must not be a generic email

Taxation details

To assist with timely processing of applications, we require the following information. Byproviding this information in your application, this reduces the amount of time betweennotification of a successful grant and payment to your organisation.Auspicing organisations: If your organisation is being auspiced, you must provide theauspicing organisations ABN.

Organisation Australian Business Number (ABN) *39 662 387 026Information from the Australian Business RegisterABN 39 662 387 026 Entity name The Scout Association Of Australia Victorian Branch ABN status Active Entity type Other Incorporated Entity Goods & Services Tax (GST) Yes DGR Endorsed Yes ATO Charity Type Charity More informationACNC Registration Registered Tax Concessions FBT Rebate, GST Concession, Income Tax Exemption Main business location 3149 VIC Information retrieved at 12:06pm yesterday

Must be an ABN. If a peak body/auspice with an ABN is applying on your behalf, please enter theauspicing organisations ABN.

Incorporated association registration number OR name registered with ACNC,Consumer Affairs Victoria or ASIC *The Scout Association of Australia Victorian Branch For incorporated associations, specify the number registered with Consumer Affairs Victoria https://www.consumer.vic.gov.au/clubs-and-fundraising/incorporated-associations/search-for-an-incorporated-association For companies limited by guarantee, specify the name registered with ACNC https://www.acnc.gov.au/charity For non-trading/non-distributing co-operatives, specify the name registeredwith Consumer Affairs Victoria https://online.justice.vic.gov.au/cav-clp/search.doj For indigenouscorporations, specify the name registered with ASIC. For local government entities, specify the legalentity name.

Is your organisation a Government Related Entity (GRE)? *○ Yes ◉ NoIf your organisation is a Government Related Entity, no GST will be paid to you in this grant under thebasic rules in the GST Act. For more information please see https://www.ato.gov.au/business/government-entities/in-detail/gst-and-payments-between-government-related-entities---overview/

Is your organisation exempt from paying income tax under the Income TaxAssessment Act 1997? *○ Yes ◉ NoSelect "Yes" if your organisation does not need to pay income tax or lodge income tax returns. For

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http://abr.business.gov.au/HelpTaxConcessions.aspx

https://www.consumer.vic.gov.au/clubs-and-fundraising/incorporated-associations/search-for-an-incorporated-association



https://www.acnc.gov.au/charity

https://www.acnc.gov.au/charity

https://online.justice.vic.gov.au/cav-clp/search.doj

https://www.ato.gov.au/business/government-entities/in-detail/gst-and-payments-between-government-related-entities---overview/

https://www.ato.gov.au/business/government-entities/in-detail/gst-and-payments-between-government-related-entities---overview/


more information please visit https://www.ato.gov.au/Non-profit/your-organisation/do-you-have-to-pay-income-tax-/income-tax-exempt-organisations/

Is your organisation registered for GST? *◉ Yes ○ No

On what basis does the organisation prepare its financial reports? *◉ Financial year (1 July - 30 June)○ Calendar year (1 January - 31 December)○ Other:If 'Other' please specify date/month to date/month

GST registered

If your organisation is registered for GST and your application is successful, doyou agree to us issuing an invoice on your behalf for the purpose of this ShadeGrant? *◉ Yes ○ NoIf you do not agree to this statement, then your organisation will be required to issue a tax invoice tothe Department of Health prior to to receiving payments

Details for the electronic transfer of payments

The Department of Health (the department) will only make a payment to a nominatedaccount held at a registered financial institution.The department is committed to protecting the privacy of your personal information.The department endorses fair information handling practices and uses of information incompliance with its obligations under the Information Privacy Act 2000 (Vic). Personalinformation will be used only for the purpose/s intended and where the intention includes confidentiality, information will be treated as such unless otherwise required by law.Auspicing organisations: If your organisation is being auspiced, you must provide theauspicing organisations bank account details.

Financial institution name *National Australia Bank

Branch address *288 Lygon St Carlton VIC 3053 Australia Address Line 1, Suburb/Town, State/Province, Postcode, and Country are required.

Bank Account *Account Name: Scout Assoc of Aust

Vic BranchBSB Number: 083355Account Number: 515564710Must be a valid Australian bank account format.

Please double-check the bank account details you have entered above.

If your organisation has previously received funding from the department, andyour bank account details have changed please indicate below. *

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https://www.ato.gov.au/Non-profit/your-organisation/do-you-have-to-pay-income-tax-/income-tax-exempt-organisations/

https://www.ato.gov.au/Non-profit/your-organisation/do-you-have-to-pay-income-tax-/income-tax-exempt-organisations/


○ Yes, we have previously been funded by the department and the bank account detailshave changed◉ Not applicable

Sun protection measures

Has your organisation previously received any funding from the Shade GrantsProgram? *◉ Yes ○ No

Does your organisation have a UV or sun protection policy? *◉ Yes ○ NoAll applicants will be required to demonstrate their broader commitment to sun protection practices bysubmitting a UV or sun protection policy upon completion of the project through the acquittal form

Has the UV or sun protection policy been actively implemented? *◉ Yes ○ No

Has the UV or sun protection policy been reviewed within the last three years? *◉ Yes ○ No

Overview of project


Project details

The following sections require you to provide an overview of your project. If the work relatesto more than one site, provide an overall description at the organisation level.

Please select all types of shade/ sun protective items that your organisation is applying for.IMPORTANT: 'Sun protective items' refers to small personal items such as hats, sunscreenand sun protective clothing only

What are you applying for? *☐ Permanent shade☐ Repair or replacement of existing permanent shade☐ Natural shade

☐ Sun protective items

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Once your project options are selected, you will need to fill out specific project details.

☐ Portable shade


Project budget


Expenses

Please list all costs required for your project. All amounts you enter must include GST.

• You only need to enter amounts for the relevant shade types you are applying for• You may delete, leave blank or enter $0, for the sections that are not applicable to yourproject

• Justification should be provided in your application if the higher quote is preferred byyour organisation.

• All expenses need to be itemised in your accompanying quotes.• Please be specific under the following expenses:

• Other items funded, e.g.'Site preparation costs', 'Costs associated with gainingrelevant permits or approvals' or 'Installation and construction costs'

• Other items NOT funded by Shade Grants Program, e.g. logo/printing costs

Expenditure Amount ($ including GST)

Permanent shade

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Add your Group project expenditure amount


Repair / replacement shade

Natural shade

Portable shade

Sun protective items

Other items funded (e.g. site preparationcosts, installation and construction costs)

Other items NOT funded by Shade GrantsProgram (e.g. logo/printing costs)

Income

Please list all income sources for your project. All amounts you enter below must includeGST.

• Applicants are not required to provide additional income sources for the project• You may delete, leave blank or enter $0, for the sections that are not applicable to yourproject

• Important for unconfirmed income sources - If a source of funding is unconfirmed,please specify in the table below. For example, if your organisation has applied foranother grant to support your project but the funding has not been confirmed, thedescription could be 'Local council infrastructure grant (unconfirmed)'

Income Amount ($ including GST)

Community Shade Grants Program totalamount requested

Cash co-contribution

Donations

Other grant funding (please specify details &if unconfirmed)

Budget Totals

The Budget Totals are automatically calculated from the information you provide in thetables above.

Total Income (Amount including GST)Your Group project income

Total Expenditure (Amount including GST)Your Group project expenditure

Income - Expenditure$0.00 This number/amount is calculat-

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Note: Income and expenses must equate to the same amount

Add your Group project income amount


This number/amount is calculat-ed.

This number/amount is calculat-ed.

ed.Note that 'Income - Expenses'must be zero (0)

Amount requested from Community Shade Grants Program

Please carefully enter the amount that you are requesting from the Community Shade Grants Program.Please ensure you have double-checked all the figures entered in this section. Any inconsistencies will automatically make your application ineligible for assessment.

Total amount requested from Community Shade Grants Program (including GST) *Amount requested by GroupMust be a dollar amount and no more than 50000.

Total amount requested from Community Shade Grants Program (excluding GST)Amount requested by GroupThis number/amount is calculated.

Required documentation* indicates a required field

Project quotes

Please ensure that you provide two project quotes for EACH type of shade.

• For example, if you are applying for permanent shade and natural shade, you need 2quotes for your permanent shade project and 2 quotes for your natural shade project.

• These quotes need to be from two different suppliers• Include quotes for any 'Other funded' itemsyou are applying for• Justification should be provided in your application if the higher quote is preferred byyour organisation.

•

Project quote 1 (Preferred quote/s) *

Attach quote for Group projectA minimum of 1 file must be attached.2 quotes are required for EACH type of shade

Project quote 2 *

Attach quote for Group projectA minimum of 1 file must be attached.

Supporting documentation

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Letter of support/approval *

Email [email protected] for a letter of support.A maximum of 1 file may be attached.

Financial statement/ annual report *

Scouts Victoria's Annual Reports are available on the Scouts Victoria website here. A minimum of 1 file must be attached.

Additional documents to support applicationUpload any additional documents to support your Groups project.For example, your organisation may wish to include a copy of your incorporation certificate or company registration.

Feedback, Review and Submit


Certification

This must be completed by the applicant.I certify that to the best of my knowledge the statements made within this application are true and correct, and I understand that if the Department of Health approves the grant, I will be required to accept the terms and conditions of the grant as outlined in the grant application, policy and/or letter of approval.

I agree *◉ Yes ○ No

Authorised Signatory *Group Leader/Group Representative name

Position held in organisation *Group Leader/Group Representative position title

Date of declaration *Must be a date.

How did you hear about the Community Shade Grants Program? *

☐ Media release from Minister for Health☐ Notification from the Shade Grants Program☑ Department of Health website☐ Grants Victoria☐ Sport and Recreation Victoria☐ SunSmart☐ Other:

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https://scoutsvictoria.com.au/about-us/annual-reports/


Privacy Notice

In line with the Privacy and Data Protection Act 2014 (Vic) the personal information on thisform is collected by the Department of Health for the purposes of administering your grantapplication and informing Members of Parliament of successful applications.In addition information in this form may be disclosed to the Department of Education andTraining, the Cancer Council Victoria SunSmart Program, and other external experts for thepurposes of assessing your application, and supporting shortlisted applicants to meet sunprotection policy requirements.You can request access to your personal information by emailing [email protected]. Otherwise, contact the Department’s Freedom of Information unit on (03) 9096 8449.

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mailto:[email protected]

mailto:[email protected]

Eligibility conﬁrmation

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