Name of Organisation
Contact Person First Name
Contact Person Last Name
Position
Street Address
Suburb
Postcode
Postal Address
Suburb
Postcode
Telephone Numbers
Mobile Number
Email Address
Website
ABN Number
Incorporation Number
Deductible Gift Recipient	Yes No
Registered for GST	Yes No

Describe the services that your organisation provides to the community:
Number of Staff
Fulltime
Part-time
Voluntary

Project Name (if applicable):
Project Summary:
Time Frame:
Start Date:	Day12345678910111213141516171819202122232425262728293031 MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Select
Finish Date:	Day12345678910111213141516171819202122232425262728293031 MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Select
Justification for the project:
What are the projects objectives:
How will your project be evaluated:

Please specify age group of beneficiaries:
Primary Target Group:
Location (must be within Western Australia):	Metro (Perth city & suburbs): Regional: Country:
How many people will this project directly impact on:
What are the benefits of this project to the beneficiaries:

Total cost of project:
Amount requested from the SMC Foundation of WA, List other Corporate/Community supporters associated with this project:

How would the support of the SMC Foundation of WA be acknowledged:

I am an authorised representative of (name of organisation). To the best of my knowledge the information I have provided on this application form is correct. If we are successful in receiving funding from The Scottish Masonic Charitable Foundation of Western Australia the funds will be used exclusively for the purposes described in this application for, unless otherwise agreed upon by the Scottish Masonic Charitable Foundation of WA

Print Name
Position in organisation
Date

Anything else / supplementary (not mandatory)

You are more than welcome to submit any additional items you feel may be relevant to your application, including:

• video/DVD/printed material of proposed program if available
• media stories that you have generated relevant to your program
• any research to validate the rationale for your program (if it is new/proposed)
• your organisational profile or credentials document/PowerPoint/DVD
• your annual report and accounts
• detailed project budget.

Questions

If you have any questions please feel free to email us at grants@smcfwa.com.au and we will endeavor to provide you with an answer as soon as we can.

Thank you

We understand the amount of effort that goes into applying for funding and we would like to take this opportunity to thank you for taking the time to submit this application and look forward to reviewing it.