You are here:HomeSustainabilityCommunityCommunity Support GrantsCommunity Support Grants Form Community Support Grants Form Applicant Details Organisation (registered name): Community Support 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 Gore Bay Newport Pinkenba Clyde Phone Email: Postal Address: 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) : 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 project (note: projects are expected to be completed within 12 months of the grants being awarded.) What are the benefits to Viva Energy in supporting this project? Provide details for how the project will be promoted including recognition of Viva Energy. Expenses Attachments max size = 5MB each Project budget : Have you read the fact sheet?* Have you read the fact sheet?* - 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: refreshGet Audio Code Type the code from the image Mandatory field(s) marked with *