VICFORESTS COMMUNITY SUPPORT PROGRAM

APPLICATION FORM
Name of your group or organisation .…………………………………………………….….........................................
Postal address …………………………………………………… Suburb …………………..………………………….
Postcode …………….……………………………...................... Website ………………………….…………………

Contact: Mr/Mrs/Ms ……………………………………………… Position ……..……………………..……….………

Daytime contact no .……………………………………………… Mobile …………………..…..………………………
Email …..…………….……………………………………………………………………………………………………….

Is your community group incorporated? If so, what is your ABN?

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Is your organisation registered for GST? (pls circle) Yes No

Describe the project/event or initiative you are seeking funding

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Who is the project or initiative aimed at? eg primary school children, senior citizens, families
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How will the community benefit from this project?
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Where and when will the project/event/initiative be conducted?
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How much funding are you seeking? (up to $2000) $…………………………………………………………………...

Please outline how the funding will be spent
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Please attach additional information to support your application, as required.
I hereby certify that I have been authorised by (your organisation’s name)……………………………………………………..
to submit this application and that the information contained herein to the best of my knowledge to be true and correct. On
behalf of my organisation I agree to abide by the VicForests Community Support Program Guidelines and I understand
that any decision by VicForests is final and will not be challenged by my organisation. I agree on behalf of my organisation
that if our application is successful, that prior to any funds being provided my organisation will be required to enter into a
Sponsorship Agreement which will govern the provision of sponsorship funds.

Name: …………………………………………………………………………………………
Signature: ……………………………………… Date: ……/……/……

Forward your completed Application to:

For applicants located in the Central Highlands region forward your application to:
Liz Langford
Community Relationship Manager
liz.langford@vicforests.com.au
213 Maroondah Highway
Healesville Vic 3777
Fax: 03 5969 9090

For applicants located in the East Gippsland region forward your application to:
Mick Sutton
Community Relationship Manager
mick.sutton@vicforests.com.au
171 Nicholson Street
Orobost Vic 3888
Fax: 03 5161 1300

APPLICATIONS CLOSE Friday 5th November, 2010

Applicants will be notified within 14 days of the closing date.