Assistance Application

Use this form to apply for financial or in-kind assistance from the Club

Please Note: Photographs are NOT required. We may ask for any supporting photographs at a later stage.

Is the Applicant an Organisation or Individuals(s)? *OrganisationIndividual(s)

The Beneficiary - who will benefit from this assistance? (max 250 characters): *0 / 250

Does the Beneficiary know that this application is being made? *YesNo

The Primary Contact - details of the Person making this application:

Your Name: *

Your Mobile Phone Number: *

Your Email Address: *

Details of any Alternative Contact:

Alternative Contact Name:

Alternative Contact Mobile Phone Number:

Alternative Contact Email:

Details of the Assistance requested

$ Amount requested:

In-kind assistance requested (eg volunteers, working bee etc - max 350 characters):0 / 350

Why do you need this help? (max 350 characters): *0 / 350

What will the assistance achieve? (max 350 characters): *0 / 350

When will you need the help? (max 350 characters): *0 / 350

Have you previously applied for and/or received funding from Rotary or any other source? *YesNo

Do you have a budget for the application of the funds raised? *YesNo

Please provide any further information that you consider relevant to our initial assessment of this application (max 350 characters):

DECLARATION / AUTHORISATION Statement of the Primary Contact:

All items must be ticked for the Application to be processed *

(1) To the best of my knowledge and belief the information provided in this application is true and correct

(2) To the best of my knowledge and belief a full and accurate disclosure of income and expenditure for the project proposed has been made herein

(3) Submission of an application does not guarantee approval for either all or part of the assistance being requested

(4) Incomplete applications cannot be processed

(5) Any further information deemed necessary to properly assess this application will be provided within 5 working days

(6) I acknowledge that further Approval Conditions may apply (eg copies of expense invoices, presentation at a Club meeting etc)

Rotary Club of Cairns Sunrise Inc – Assistance Application Form