Connect with us:
Linkedin
Twitter
Youtube
Driven by People
Media
Blog
Careers
Contact Us
Search
Search
Search for
Loading results...
More Results
Close
Skip to main content
Navigation
About Us
About Viva Energy
Executive Team
Audited Financial Statements
Our History
Our Values and Business Principles
Our Retail Network
Terminals and Refinery
Geelong Refinery
About Us
Our History
Our Operations
Environment
Contact Us
Community
Projects
Refinery Updates
Open Day
Clyde & Parramatta Terminals
Alarms
Community
Conversion Project
Emergency Response
Environmental Licence
West Area Remediation Project
Gore Bay Terminal
Alarms
Community
Emergency Response
Environmental Licence
Project Updates
Newport Terminal
About Us
Environmental Licence
Community
Emergency Response
Alarms
Pinkenba Terminal
Our Pipelines
Careers
Current Opportunities
HSSE
Safety
Safety Data Sheets
CMAS
Community Program
Our People
Our Communities
Our Community Partners
Our Business
Indigenous Participation
Media Centre
News
2014
2015
2016
2017
2018
2019
Media Enquiry
Environment and Sustainability
Shell V-Power Racing Team
Investor Centre
Viva Energy Group Limited (VEA)
Viva Energy REIT (VVR)
Products
Product Guide
Shell Card
Apply for a Shell Card
Competitive Pricing
Shell Card Online
Shell Fuels & Network
Fuels
Shell V-Power
Shell Premium 98
Shell Unleaded 95
Shell Unleaded 91
Shell Unleaded with Ethanol
Shell Unleaded 91 Low Aromatic
Shell V-Power Diesel
Shell Diesel Extra
Shell Diesel
Shell Autogas
AdBlue®
Oils, Lubricants and Grease
Agriculture
Car
Construction
Coolants
Industrial
Marine
Mining
Motorcycle & Scooter
Trucks & Buses
Product Guide
Bitumen
Test Reports
Where to buy
Fuel Finder
Lube Locator
Truck Atlas
Chemicals
Terminal Gate Pricing
Current TGP
Historical TGP
New Customers
Community Program
Services by Industry
Aviation
JetValet
Fuel2sky Card
Marine
Vetting and SIRE Inspections
Mining
Transport
Commercial Fleets
Tools & Resources
Terminal Gate Pricing
Safety Data Sheets
Technical Data Sheets
Fuel Quality Claims Process
Shell Fuel Finder
Shell Lube Locator
LubeMatch
Shell Truck Atlas
Login
Shell Card Online
eInvoice
You are here:
Home
About Us
Community Program
Role Model Grants Form
Applicant Details
Role Model Grants are available for ACNC organisations only. Please entre your ACNC number:
*
- required
Key Contact Name
Title of Key Contacts
Location your project is closest to
Geelong
Clyde/Gore Bay / Parramatta
Newport
Pinkenba
Phone
Email:
Postal Address:
Organisation (registered name):
Mission of your organisation (as stated in your documentation)
Not for profit organisation:
Yes
No
Project details:
Project name:
Requested dollar amount ($5,000 max) :
Which significant community challenge does this project best fit?
Mental illness
Substance abuse
Breaking the poverty cycle through education
Project description: aim, need, outcome?
What is the project’s objectives?
What do you propose to do, why and how?
Who will directly benefit and how many?
How are positive role models central to this project?
Impact, what would success look like at the end of this project? Specifically what would we be celebrating at the end of the project?
Critical dates/milestones for the projects (Note projects are for up-to-12 months: Nov to October)
What are the benefits to Viva Energy in supporting this project?
How will you provide recognition to Viva Energy?
Expenses
Attachments max size = 5MB each
Project budget :
Have you read the guidelines?
*
- required
Yes
No
Applications will only be considered with the following information
Latest audited financial statements (for requests of $1000 or more):
List of Board of Directors or governing body
Attachment to most recent annual report:
Link to the most recent annual report
Is an elected official of any type(or immediate family member of an elected official)is a director, manager, trustee or person with governance or financial responsibility with
yes
No
the applicant organisation?
Any additional information
Signature:
Date:
Mandatory field(s) marked with *