NQBP Grassroots Donations Application Form

Organisation Name *

ABN *

Organisation Address *

Street address *Street address line 2

City *

State *

Postcode *

Country

Applicant's full name *

Position/Title *

Phone Number *

Email Address

Initiative Information

Project Name *

Start Date *

End Date

Brief Description of the initiative or project (150 words or less) *

Which of the following focus areas does your initiative support (select all that apply) *

YouthDiversity and inclusionSportEnvironmentEducationArts and CultureCommunity eventsCommunity wellbeing

How will this make a difference in the community? *

Funding

Amount requested (between $500 and $1000 *

What will the funding be used for? (e.g., equipment, uniforms, venue hire, promotion, materials) *

Do you require in-kind support from NQBP? *

YesNo

If yes, please specify:

Awareness and Benefits

Which port community will your initiative / project / event benefit? *

Hay PointMackayAbbot Point (Bowen)Weipa

Describe how your initiative/project will promote/raise awareness about NQBP and/or port operations?

What promotional or recognition opportunities can you offer NQBP? Select all that apply *

Media release/s / media articleSocial mediaAdvertising (print, online, radio)SignageOther

Supporting Information

Do you have public liability insurance? *

YesNo

Do/will you comply with all local laws, applicable regulations and have the correct insurance in place for the event/organisation? *

YesNo

Have you previously received funding from NQBP? *

YesNo

If yes, please specify:

Is there a link to any NQBP employees? *

YesNo

Upload any supporting documents

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Evaluating our partnership

Do you agree to complete an evaluation survey on completion of your initiative / project / event? *The survey will assist NQBP in evaluating the partnership and the resulting benefits to the port community. *

YesNo

For security please complete the check below *

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NQBP complies with the requirements of the Privacy Act 1988 (Cth) and the Information Privacy Act 2009 (Qld). By providing your personal information, you consent to NQBP using it for the purpose of administering the NQBP Community Fund and Grassroots Donation Program, and to keep you informed about future funding opportunities. NQBP will not disclose your personal information to third parties without your consent, subject to legal requirements