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Community Partnership Program Application

Contact Information

Full name of organisation *

Contact name *

Position *

Telephone *

Mobile *

Email *

Social media handles/URLs *

Street Address *

Address Line 1

City

State / Province / Region

Postal Code

Postal Address (If different)

Address Line 1

City

State / Province / Region

Postal Code

ABN (If applicable) *

Sponsorship request

Amount Requested *

(inclusive of GST)

Timeframe *

Period of time project will run

Project Name

Please provide the name of the project for which you are seeking sponsorship *

Project summary

Please provide a brief summary of the project – specifically how and when the funds would be used and any anticipated project outcomes *

Budget

Please briefly outline the total budget of the project for which you are seeking sponsorship (indicating what percentage will be covered by the Busselton Water sponsorship funds) *

Does your organisation receive sponsorship or funding from other sources? If yes, please specify. *

Background information

Please provide a brief background of your organisation (how long it has been in operation, your objectives and purpose, your membership profile, as applicable). *

Please include any relevant dates (project timeframes and milestones) that would apply to the sponsorship proposal (e.g. event date or start of season or activity date/s). *

Please list the benefits to Busselton Water of sponsoring the project and the estimated value of each benefit (e.g. logo recognition, signage, member database access, media exposure, publicity and other promotional opportunities) *

Evaluation

Evaluating each community sponsorship activity is important to the ongoing success of the Busselton Water Community Partnership Program. Successful applicants will be provided with a Sponsorship Evaluation Template and all sponsored organisations will be asked to complete this within four weeks of completion of the sponsorship.

Declaration

Declaration *

I declare I am authorised on behalf of organisation nominated above to apply for and administer sponsorship funds for the project declared above.

Signature *