Application Form

APPLICATIONS OPEN

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1Contact Person Details

2Organisation Details

3Application Details

4Application Details Cont.

5Bank Details & File Uploads

Contact Person Details
Name*
Title* First Name* Last Name*
Position*
Phone*
Email*

Save Progress

Organisation Details
1. Name of Organisation*
2. Name of Organisation as it appears on your DGR/TCC Certificates*
3. Postal Address*
4. Website Address (www.yourwebsite.com)*
5. ABN/ACN of Organisation*
6. Date of DGR Endorsement*
DD slash MM slash YYYY
7. Date of TCC Endorsement*
DD slash MM slash YYYY
8. Total of last year's revenue/ income*
9. Percentage of total revenue received from Government sources (Local, State & Federal)*
10. Total forecasted budgeted expenditure for current Financial Year (total budgeted cost of all your Organisation's planned programs this year)*
11. Your Organisation's background & purpose:*
12. Summarise the major programs your Organisation has undertaken within the last 12 months:*
13. Briefly describe two of the most significant accomplishments your Organisation has achieved for the benefit of the population or community you serve and the month and year they were achieved*

Save Progress

Project/Program Details
14. Project/ Program Title*
15. Description of the Project/ Program for which the Grant is sought*
16. Total Budget (expenditure) for this Project/ Program*
17. Amount requested from The Pierce Armstrong Foundation (ex GST)*
18. If the applicant is applying through an auspicing body with DGR status or is a department or a subset of an institution such as a University, please state whether an administration fee or similar will be applicable to a successful grant application and if so the quantum.*
19. If the applicant is using a fee for service fund raising entity, state the percentage applied to a successful grant application.*
20. Timetable for Project/ Program implementation
Commencement Date*
DD slash MM slash YYYY
Completion Date*
DD slash MM slash YYYY
21. Have you been successful in securing funding for this project from other Trusts, Foundations, Corporations and other funding sources, including Government?*
- Yes
- No
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY

Save Progress

Project Details Continued
22. Indicate under which of our Key areas your Project/ Program falls within*
23. What will happen with the project/ program if all funding is not received?*
24. Geographic location of the people to be served by this Project/ Program (please tick one area only and nominate location)*
Other, please specify
25. Project Location*
26. Is this the first application your organisation has submitted to our foundation*
- Yes
- No
If this is not the first Application, what was the date of the most recent application and what amount was received if any?:
Date
DD slash MM slash YYYY
Amount Received

Save Progress

Bank Account Details
27. Name in which your account is held*
28. Name of Financial Institution*
29. Address of Financial Institution*
30. BSB No.*
31. Account No.*
File Uploads

Maximum file size 8MB per file

Please do not move off this page until you get redirected to the thank you page.
32. Deductible Gift Recipient (DGR) Certificate~*
Max. file size: 8 MB.
33. Charity Tax Concession (TCC) Certificate~*
Max. file size: 8 MB.
34. Annual Report (Soft Copy)~*
Max. file size: 8 MB.
~A hard copy of your organisation’s Annual Report may also be requested.

Save Progress

Application Form

1Contact Person Details

2Organisation Details

3Application Details

4Application Details Cont.

5Bank Details & File Uploads

Contact Person Details
Name*
Title* First Name* Last Name*
Position*
Phone*
Email*

Save Progress

Organisation Details
1. Name of Organisation*
2. Name of Organisation as it appears on your DGR/TCC Certificates*
3. Postal Address*
4. Website Address (www.yourwebsite.com)*
5. ABN/ACN of Organisation*
6. Date of DGR Endorsement*
DD slash MM slash YYYY
7. Date of TCC Endorsement*
DD slash MM slash YYYY
8. Total of last year's revenue/ income*
9. Percentage of total revenue received from Government sources (Local, State & Federal)*
10. Total forecasted budgeted expenditure for current Financial Year (total budgeted cost of all your Organisation's planned programs this year)*
11. Your Organisation's background & purpose:*
12. Summarise the major programs your Organisation has undertaken within the last 12 months:*
13. Briefly describe two of the most significant accomplishments your Organisation has achieved for the benefit of the population or community you serve and the month and year they were achieved*

Save Progress

Project/Program Details
14. Project/ Program Title*
15. Description of the Project/ Program for which the Grant is sought*
16. Total Budget (expenditure) for this Project/ Program*
17. Amount requested from The Pierce Armstrong Foundation (ex GST)*
18. If the applicant is applying through an auspicing body with DGR status or is a department or a subset of an institution such as a University, please state whether an administration fee or similar will be applicable to a successful grant application and if so the quantum.*
19. If the applicant is using a fee for service fund raising entity, state the percentage applied to a successful grant application.*
20. Timetable for Project/ Program implementation
Commencement Date*
DD slash MM slash YYYY
Completion Date*
DD slash MM slash YYYY
21. Have you been successful in securing funding for this project from other Trusts, Foundations, Corporations and other funding sources, including Government?*
- Yes
- No
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY
Name
Amount
Date by which you expect to receive funds
DD slash MM slash YYYY

Save Progress

Project Details Continued
22. Indicate under which of our Key areas your Project/ Program falls within*
23. What will happen with the project/ program if all funding is not received?*
24. Geographic location of the people to be served by this Project/ Program (please tick one area only and nominate location)*
Other, please specify
25. Project Location*
26. Is this the first application your organisation has submitted to our foundation*
- Yes
- No
If this is not the first Application, what was the date of the most recent application and what amount was received if any?:
Date
DD slash MM slash YYYY
Amount Received

Save Progress

Bank Account Details
27. Name in which your account is held*
28. Name of Financial Institution*
29. Address of Financial Institution*
30. BSB No.*
31. Account No.*
File Uploads

Maximum file size 8MB per file

Please do not move off this page until you get redirected to the thank you page.
32. Deductible Gift Recipient (DGR) Certificate~*
Max. file size: 8 MB.
33. Charity Tax Concession (TCC) Certificate~*
Max. file size: 8 MB.
34. Annual Report (Soft Copy)~*
Max. file size: 8 MB.
~A hard copy of your organisation’s Annual Report may also be requested.

Save Progress

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APPLICATIONS OPEN

Application Form

Contact Person Details

Organisation Details

Project/Program Details

Project Details Continued

Bank Account Details

File Uploads

Application Form

Contact Person Details

Organisation Details

Project/Program Details

Project Details Continued

Bank Account Details

File Uploads