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Community Investment Application Form

Applicant Information
Name of organisation:*
Australian Business Number (ABN):*
Organisation Status:*
Deductible Gift Recipient endorsment:*
Type of organisation:*

 

Geographical reach:*
Connection to Rye, Dromana and Rosebud Community Bank® Branches
Does your organisation have an existing banking arrangement with the Rye, Dromana or Rosebud Community Bank® branches?*
BSB:
Account Number:
How did you hear about funding available through Rye and District Community Financial Services Ltd?*

 

Has your organisation previously received funding from Rye and District Community Financial Services Ltd?*
Has your organisation received funding from another financial institution in the past two years?*
Details of Request
Describe the community initiative this requested investment will support.*
What do you expect the community initiative to achieve? (Please detail)*
How many people do you anticipate being positively affected by this community initiative? (Please detail)*
What will this community initiative contribute to a strong community on the Southern Mornington Peninsula?*
Please provide detail on each item above.*
Anticipated total value of this community initiative:*
Investment requested from Rye and District Community Financial Services Ltd to support this community initiative:*
Is this request for a one-off or recurrent investment?*
Does your organisation have existing partnerships with other businesses, local / state government or community organisations to support the realisation of the community initiative you are requesting funds for? (Please detail the commitment from each and whether you have collaborated before)*
How will the investment requested from Rye and District Community Financial Services be allocated? (Please detail the dollar amount allocated to each aspect of the community initiative to be funded under this request)*
What opportunities for promotion can your organisation offer the Rye, Dromana and Rosebud Community Bank® branches? (Please provide detail on each intended opportunity)*
Is there any other information you would like to provide in support of your application?*
Would you be willing to speak with a representative of Rye and District Community Financial Services Ltd about your application?*
Contact Information
Address:*
Phone:
E-mail:*
Website:
Facebook:
Contact 1:*
Contact 1 Position:*
Contact 1 Phone:
Contact 2:
Contact 2 Position:
Contact 2 Phone:
Declaration

I declare that, on behalf of my organisation, I have read and agree to the Rye and District Community Financial Services Ltd Conditions of Funding and that the information in this application is true and correct.

Agree
Your Community Bank® funding will only be provided to organisations. These organisations must:
  • operate on the Southern Mornington Peninsula;
  • be of a not-for profit nature;
  • maintain banking status with Rye and District Community Financial Services Ltd.
In receiving funding, organisations agree to:
  • attend the allocated funding awards ceremony in either April or October;
  • provide Your Community Bank® with a receipt evidencing payment of the funding within 5 business days of receiving funds;
  • only use the funds as outlined in the relevant application form;
  • spend the allocated funds within 12 months of receipt;
  • report on the use of funds at the conclusion of the 12 month period;
  • return any funds unused in the 12 month period;
  • provide mutually agreed opportunities to promote Your Community Bank® to stakeholders through speaking engagements, etc.;
  • be included in various promotional material and mediums;
  • ensure that any person associated with the organisation consents (or has a parent/guardian consent on their behalf) for their image or likeness to appear in media;
  • receive correspondence from Your Community Bank®;
  • participate in any surveys conducted by Your Community Bank® regarding the funding.

Name:*
Position:*
Date: