ANIKA WELLS MP

STRONGER COMMUNITIES PROGRAM

EXPRESSION OF INTEREST
Your Organisation:

Organisation name
Where you have a sponsor arrangement, this must be the
name of the sponsor organisation who is eligible to apply.

ABN

What type of entity are you? Incorporated Not-for-profit Organisation

You may be required to provide proof of incorporation if
applicable.
State government agency that is a fire service, country fire
authority, state emergency service or similar

Local Governing Body e.g. Local council

(This will limit your grant to 50% of eligible project
expenditure
Are you a trustee on behalf of a trust?
If yes, please provide both the Trust and the Trustee’s Trust ABN:
ABN. Trustee ABN:

Are you a charity registered with the

Australian Charities and Not-for-profits
Commission (ACNC)?

Are you registered for GST? Yes No Unsure

Organisation street address

Please provide a street address, not a post box address.

Organisation postal address

You may provide a post box address here.

Sponsored organization (where applicable):

Are you applying as a sponsor on
behalf of an unincorporated
organisation?

Sponsored organisation name

 Nominee Contact Details:
Name

Position in organisation

Email Address

Telephone number

Mobile number
(optional)
Address
Enter ‘as above’ if using the organisation address

Your Project:
Project title

Project description
What are your key project activities and outcomes?

Project outcome/Why is the project

important?
Explain how your project supports and encourages local
community participation and delivers social benefits to the
local community.

Project site location

Please ensure this street address is within the nominating
electorate.

% of project value undertaken at site

Total cost of project

Grant funding sought

Local Governing Bodies (LGAs) can only apply for a grant
amount of 50% of eligible project costs. LGAs must
provide matched funding contributions towards their
eligible project.

Can you complete the project by 31st

Yes No Unsure
December 2022?
Final applicants will be invited to submit a formal application which will be assessed by the AusIndustry Grants Hub. Grants will not be
ongoing. Please attach any supporting documentation i.e. plans, prices etc.

Your Declaration:
I declare that the details provided above, to the best of my knowledge, are true and correct.
Expressions of Interest close 5pm, Friday 19th November 2021
Please return to: Anika Wells MP, PO Box 182, Nundah, QLD 4012 or email anika.wells.mp@aph.gov.au

1176 Sandgate Road, Nundah, QLD 4012 I (07) 3266 8244

instagram@anikawellsmp I facebook.com/anikawellsmp I twitter@anikawells
Authorised and Printed by A Wells, 1176 Sandgate Road, Nundah