Local Sport Grant Program 2021/22 Application Form Preview ...

Local Sport Grant Program 2021/22 ApplicationForm Preview

Eligibility* indicates a required field

Previous Office of Sport funding

Has your organisation received previous grant funding from the Office of Sport? *○ Yes ○ No

Do you have any funded projects prior to 2019/20 that have not yet beenacquitted? *○ Yes ○ No

IMPORTANT INFORMATION

It is very important that applicants work through the form in sequence, including theeligibility requirements. Questions asked throughout the application are based on yourresponses provided in the initial sections of the application.

About the Local Sport Grant Program (LSGP)

The Local Sport Grant Program aims to increase regular and on-going participationopportunities in sport in NSW. Through this program we are working towards our goals toachieve:

• Participation: Everyone in NSW participating in sport and recreation throughout theirlife

• Places and Spaces: Everyone in NSW having access to places and spaces for sportand active recreation

• Sustainability: The sector continues to grow sport and active recreation across NSW.

Eligibility Overview

Before you apply please read the guidelines and related materials to make sure youunderstand all relevant requirements.You can find information Program GuidelinesAll grant applications must meet the following mandatory criteria to progress tofull assessment:

• be lodged by an incorporated, not-for-profit grassroots sport club• the project must be based in NSW• be an eligible project (refer to Program Guidelines)

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https://www.sport.nsw.gov.au/sites/default/files/2021-10/lsgp_guidelines_2021-22.PDF


Eligible applicants

Eligible applicants are:

• Incorporated, not-for-profit grassroots ‘sport clubs’ whose primary focus is to organisesporting activities; deliver ongoing sporting programs; develop member’s skills (refer tolist of sports at Appendix B

Applications from Licenced Sporting Clubs may be considered, providing the project directlybenefits the sport, not the administration processes of the licenced club or upgrades of thelicenced premisesApplications may be considered from Sport Clubs associated with a school, church oruniversity providing they are a not-for-profit club incorporated in their own right.

To be eligible for funding your organisation must be an Incorporated, not-for-profit grassroots ‘sport club’ whose primary focus is to organise sportingactivities; deliver ongoing sporting programs; develop member’s skills *○ AgreedPlease select one

Ineligible Applicants

Ineligible applicants are any organisation types not listed in the ‘Eligible Applicants’ section,and include (but are not limited to):

• Individuals, groups of individuals and unincorporated organisations• Incorporated not-for-profit organisations that are not a sport associated with the list ofsports at Appendix B of the Guidelines

• Organisations named by the National Redress Scheme for Institutional Child SexualAbuse on its list of institutions that have not joined or signified their intent to join theScheme are not eligible for funding under this program

• Clubs whose activities are considered to be of a recreational nature e.g. remote/ radiocontrolled activities, fishing

• Sporting zones or sporting groups that are not based at a specific Location within anelectorate

• Individual sporting competitions• State Sporting Organisations and State Sporting Organisations for People with aDisability

• National Sporting Organisations• Regional Academies of Sport• For profit, commercial organisations• Organisations Limited by Shares• Government departments and agencies• Educational institutions including schools and their P & Cs, Universities, TAFE, Collegesand child care centres

• Local Government Authorities operating under the Local Government Act, 1993• Local Government Committees• Organisations that are the responsibility of another Minister’s portfolio• PCYC’s/YMCA/Scouts/Gyms/Surf Life Saving

The organisation is not one of the ineligible applicants listed above *○ Agreed

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Eligible Sports

Only the sports listed below are eligible to apply, this includes Disability versions of thelisted sports (refer to the Program Guidelines)

Primary Project Beneficiary *○ Archery / Archery Field ○ Little Athletics○ Athletics ○ Motorcycling○ Australian Football League ○ Motorsport○ Badminton ○ Netball○ Baseball ○ Orienteering○ Basketball ○ Paddle Sports○ Bocce ○ Parachute○ Boccia ○ Paragliding○ Boxing ○ Pistol○ Clay Target Shooting ○ Polo○ Cricket ○ Polocrosse○ Croquet ○ Pony Club○ Cycling Track ○ Rifle○ Dancesports ○ Roller Blading○ Darts ○ Roller Derby○ Diving ○ Roller Skating○ Dragon Boating ○ Rowing○ Endurance Riders ○ Rugby League○ Equestrian ○ Rugby Union○ Fencing ○ Sailing○ Flying Disc / Ultimate Frisbee ○ Skateboarding○ Football ○ Skiing○ Gliding ○ Snooker○ Goal Ball (Blind / Vision Impaired Sport) ○ Snowboarding○ Golf ○ Softball○ Gridiron ○ Squash○ Gymnastics ○ Surfing○ Handball ○ Swimming○ Hang Gliding ○ Table Tennis○ Hockey ○ Tennis○ Ice Hockey ○ Tenpin Bowling○ Ice Racing ○ Touch Football○ Ice Skating ○ Triathlon○ Judo ○ Volleyball○ Karate ○ Water Polo○ Karting ○ Water Skiing○ Kung Fu ○ Weightlifting○ Lacrosse ○ Wrestling○ Lawn Bowls

As the primary sport user, what is the indicative percentage of use? *

Must be a whole number (no decimal place) and between 50 and 100.

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Does the project have any other beneficiaries? *○ Yes ○ No

Please ensure you do not select the beneficiary already selected as the primary projectbeneficiary above.

Other Project Beneficiaries *☐ Archery / Archery Field ☐ Little Athletics☐ Athletics ☐ Motorcycling☐ Australian Football League ☐ Motorsport☐ Badminton ☐ Netball☐ Baseball ☐ Orienteering☐ Basketball ☐ Paddle Sports☐ Bocce ☐ Parachute☐ Boccia ☐ Paragliding☐ Boxing ☐ Pistol☐ Clay Target Shooting ☐ Polo☐ Cricket ☐ Polocrosse☐ Croquet ☐ Pony Club☐ Cycling Track ☐ Rifle☐ Dancesports ☐ Roller Blading☐ Darts ☐ Roller Derby☐ Diving ☐ Roller Skating☐ Dragon Boating ☐ Rowing☐ Endurance Riders ☐ Rugby League☐ Equestrian ☐ Rugby Union☐ Fencing ☐ Sailing☐ Flying Disc / Ultimate Frisbee ☐ Skateboarding☐ Football ☐ Skiing☐ Gliding ☐ Snooker☐ Goal Ball (Blind / Vision Impaired Sport) ☐ Snowboarding☐ Golf ☐ Softball☐ Gridiron ☐ Squash☐ Gymnastics ☐ Surfing☐ Handball ☐ Swimming☐ Hang Gliding ☐ Table Tennis☐ Hockey ☐ Tennis☐ Ice Hockey ☐ Tenpin Bowling☐ Ice Skating ☐ Touch Football☐ Judo ☐ Triathlon☐ Karate ☐ Volleyball☐ Karting ☐ Water Polo☐ Kung Fu ☐ Water Skiing☐ Lacrosse ☐ Weightlifting☐ Lawn Bowls ☐ WrestlingNo more than 5 choices may be selected.

Ineligible projects or project components

Applicants must confirm that they have read and understood the ineligible projects andproject components outlined in the' Ineligible projects' section of the Program Guidelines

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This application is not for an ineligible project or project component *○ I confirm

Insurance

It is a condition of funding that applicants (funded organisations) have at least $5 millionPublic Liability Insurance.It is recommended, but not a condition of funding, that applicant organisations havePersonal Accident, Professional Indemnity and Directors and Officers insurance.Applicants that employ staff must comply with the Workplace Injury Management andWorkers Compensation Act 1998 (NSW).

The organisation has public liability insurance for at least $5 million? *○ Confirmed

Does your organisation hold Workplace Injury Management and WorkersCompensation Act 1998 (NSW) insurance? *○ Yes ○ No

It is recommended, but not a condition of funding, that applicant organisationshave Personal Accident, Professional Indemnity and Directors and Officersinsurance *○ Noted

I understand that if the application is successful, the organisation is required tomaintain a minimum Public Liability Insurance cover of $5 million for the durationof the project *○ Agreed

Please provide information on why your organisation is not required to holdWorkers Compensation Insurance *

Word count:Must be no more than 50 words.

Applicant Organisation Details* indicates a required field

Organisation *Organisation Name

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Does your organisation have an ABN? *○ Yes ○ No

Applicant ABN *

The ABN provided will be used to look up the following information. Click Lookup above tocheck that you have entered the ABN correctly. Information from the Australian Business Register

ABN

Entity name

ABN status

Entity type

Goods & Services Tax (GST)

DGR Endorsed

ATO Charity Type More information

ACNC Registration

Tax Concessions

Main business location

Must be an ABN.Please click on the following link to find your ABN: https://www.abr.business.gov.au/

Does your organisation have an Australian Company Number and/or a NSW FairTrading Incorporation Number *☐ Australian Company Number☐ NSW Fair Trading Incorporation NumberAt least 1 choice must be selected.If your organisation is a Co-op, please tick the NSW Fair Trading option

Please click on the following links to find your number/s as applicable:

• Australian Company Number• NSW Fair Trading Incorporation Number

Australian Company Number *

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http://abr.business.gov.au/HelpTaxConcessions.aspx

https://www.abr.business.gov.au/

https://connectonline.asic.gov.au/RegistrySearch/faces/landing/SearchRegisters.jspx?_adf.ctrl-state=o7h4p85a6_4

https://www.fairtrading.nsw.gov.au/help-centre/online-tools/nsw-incorporated-associations-register


NSW Fair Trading Incorporation Number *

This includes Co-op Numbers

Organisation Postal Address *Address Address Line 1, Suburb/Town, State/Province, Postcode, and Country are required. Country must beAustralia

Organisation Street Address *Address Address Line 1, Suburb/Town, State/Province, Postcode, and Country are required. Country must beAustralia

Organisation Phone Number *

Must be an Australian phone number.Please include area code eg. 02 9999 9999

Organisation Email * Must be an email address.Organisation generic email address preferable if one available.

Organisation Website

Must be a URL.

Organisation social media (e.g. Facebook, Twitter, Instagram etc. if relevant)

Authorised Organisation Contact

The Authorised Organisation Contact will receive formal correspondence from the Officeof Sport and will be the organisation's authorised delegated contact who hasdelegated authority to sign on behalf of the organisation and should be theGeneral Manager, CEO or Executive Officer, President, Organisation Board orCommittee of Management Chair.It is your responsibility to update the Office of Sport of any contact details change during thedelivery of the project.

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Name *Title First Name Last Name Position * Business Phone Number *


Mobile Phone *

Must be an Australian phone number.

Email Address * Must be an email address.

Project Contact Person

Please provide the name of the contact person from the organisation who is submittingthe application and who will be the contact person throughout the project. It is yourresponsibility to update the Office of Sport if these contact details change during thedelivery of the project.



Mobile Phone *



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Project Details* indicates a required field

Project Title * Must be no more than 10 words.Will be used in correspondence. Please capitalise the first letter of every word. A unique title thatidentifies your project.

Project Description *

Word count:Must be no more than 100 words.Please provide a short description for publication purposes (What and where)

Project Location (Home Ground)

Provide the address where your club trains, your home ground - must be located in NSW.

Name of Park/Reserve/Facility * Project Location Name

Street Address *Address

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Address Line 1, Suburb/Town, State/Province, and Postcode are required. Coordinates Required.Country must be Australia

State Electorate

LGA

Council

Applicants may apply for one application per project type but should prioritise their projectsas the maximum available to any one organisation under this round of the program is$20,000 in a financial year.

Is your organisation applying for more than one grant application? *○ Yes ○ No

How many applications is this organisation submitting? *

Maximum 4

What is your priority ranking of this project? *

This is the organisation's priority ranking of this project compared to other submitted projects.

Project Type

Projects eligible to be funded for Sport Development include:

• Training programs that will lead to volunteer coaches, officials and club administratorsgaining required education and accreditation e.g., a club could apply for funds to allow itto run a coach accreditation course

• Facilitation of programs that will increase the skill level of players/participants• Projects that improve a club’s community presence, ability to communicate withmembers or undertake administrative functions e.g., a club could develop or upgradetheir website or, purchase accounting software to assist it manage its finances

Projects eligible to be funded for Sport Event include:

• Events that promote participation in sport and physical activity and provide a focalpoint for community building and engagement e.g., a club could host a specific event/tournament within their electorate. An event must be conducted on a specified day orconsecutive days at a specified location

• Events that primarily involve sporting competition or mass participation in anorganised sport e.g., an exhibition sporting match, hosting a gala day, regional or statechampionships

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• Regional clubs host a sporting event that attracts tourists and visitors to the region

Notes: An event does not include regular ongoing weekly/monthly sporting competition/activities. The event date must be included in the application. Events must be held within 12months of funding being announced.

Events are not to be scheduled prior to 1 January 2022.

Consideration should be given to travel restrictions and scheduling when preparing for theevent.

Projects eligible to be funded for Sport Access include:

• Costs associated with overcoming a barrier to participation in sport e.g. training andplaying sport equipment

• Subsidised travel costs to assist junior teams (aged under 18 years of age) access tofirst class coaching, or travel from rural/ remote areas to participate in competition

• AEDs – Applicants must rely on their own enquiries as to the suitability of any AEDService Provider they engage.

Notes: The provision of an AED package must include:

• An AED• AED familiarisation instruction• A minimum of six years of essential defibrillator maintenance.• Medical Emergency Plan

Notes: Travel interstate will only be considered for clubs close to state borders whereaccess to competition is not available within a reasonable distance in NSW, e.g. hire of a busfor weekly competition at away ground games

Subsidised registration fees for senior players (this does not apply to juniors who are able toaccess the Active Kids vouchers)

Projects eligible to be funded for Sport Facility include projects at sporting clubsand facilities used by sports clubs that:

• Enhance existing facilities e.g., installation of watering systems, safety netting,lighting, upgrade of surfaces and installed electronic scoreboards. Provide ancillaryfacilities at established facilities e.g., fixed sun protection shelters, change rooms,shower and toilet blocks

• Are for construction of new facilities and infrastructure• Have received development approval (DA) from the relevant Council or candemonstrate that such approval is not required and have evidence of landowners’consent. NB: This documentation is required before your club submits an application

Notes: This project type does not include capital equipment and/or portable equipment(this would be captured as part of Sport Access above)

Project Type *○ Sport Development○ Sport Event○ Sport Access○ Sport FacilityChoose your project type, individual applications are required for different project types

Proof of Landowners Consent

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Please attach your property or landowner’s consent *Attach a file:

Development Approval

Projects must have an approved Development Application as part of their application ordemonstrate that a Development Application is not required.

Does your project require development approval? *○ Yes ○ No

Please upload a copy of your development approval *Attach a file:

Please upload evidence that development approval is not required *Attach a file:

Facility Type

Which of these project types best represents your project? *○ Aquatic – pool○ Canteen/Kiosk/Kitchen○ Changeroom new/upgraded○ Clubhouse/Amenity○ Court resurfacing○ Cycle/running/walking trails○ Digital technology uplift/smart technology○ Grandstand○ Indoor sport facility○ Irrigation & drainage○ Lighting / smart metering○ Solar project○ Storage○ Synthetic field resurface○ Water harvesting

Which other project types represent your project? *☐ Aquatic – pool☐ Canteen/Kiosk/Kitchen☐ Changeroom new/upgraded☐ Clubhouse/Amenity☐ Court resurfacing☐ Cycle/running/walking trails☐ Digital technology uplift/smart technology☐ Grandstand

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☐ Indoor sport facility☐ Irrigation & drainage☐ Lighting / smart metering☐ Modular amenity facility☐ Solar project☐ Storage☐ Synthetic field resurface☐ Water harvesting☐ Other:

Project Data* indicates a required field

Gender and Age Groups

Which identified age group will the project primarily benefit? *○ Preschool (0-4 years)○ School Aged Children (5-11 years)○ Young People (12-24 years)○ Adults (25-64 years)○ Seniors (65+ years)○ All Age Groups

Which gender group will the project primarily benefit? *○ Female○ Male○ Non-binary○ All Genders/No specific gender group beneficiary

Self-Described

Description

Target communities

What is the primary community (if any) that your project demonstrates benefitto? *○ Disadvantaged communities (low SEIFA)○ People from culturally and linguistically diverse (CALD) backgrounds○ First Nations/Aboriginal people○ People with a disability○ Regional and remote○ None of the above

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Does your project demonstrate benefit to any other communities? *☐ Disadvantaged communities (low SEIFA)☐ People from culturally and linguistically diverse (CALD) backgrounds☐ First Nations/Aboriginal people☐ People with a disability☐ Regional and remote☐ None of the above

Merit Assessment - Program Objectives* indicates a required field

Each application will be assessed against the following criteria:

1.The project will deliver on one or more of the program’s objectives.2.The project will meet an identified need effectively.3.The applicant organisation demonstrates the capacity and experience to deliver the

project. Evidence of project partners will be considered as adding to your capacity todeliver the project.

4.The budget is reasonable and cost effective.

The key objectives of the Program align to the Office of Sport Strategic Plan2020-2024Applicants must meet at least one of the program objectives. The objective yourespond to should be relevant to your nominated project type and project focusarea.

Which of the following program objectives will the project address? *☐ Increase regular and on-going participation in sport☐ Increase participation and access for women, girls and population groups under-represented in participation including, Culturally and Linguistically Diverse (CALD)communities, people with a disability and Aboriginal and Torres Strait Islanders (ATSI)☐ Address barriers to participation in sport or structured physical activity☐ Assist sport clubs to provide quality service to their members and meet communityneedsAt least 1 choice must be selected.Select all that apply

How will the project increase regular and on-going participation in sport? *

Word count:Must be between 30 and 100 words.

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https://www.sport.nsw.gov.au/sites/default/files/2021-04/Strategic_Plan_2020-24.pdf

https://www.sport.nsw.gov.au/sites/default/files/2021-04/Strategic_Plan_2020-24.pdf


How will the project increase participation and access for women, girls andpopulation groups under-represented in participation including, Culturally andLinguistically Diverse (CALD) communities, people with a disability and Aboriginaland Torres Strait Islanders (ATSI)? *


How will the project address barriers to participation in sport or structuredphysical activity? *


Assist sport clubs to provide quality service to their members and meet community needs

How will the project assist sport clubs to provide quality service to their membersand meet community needs? *


Project Timeframe

If your application is for a 'Sport Event' project type, the start and finish date should be thedate of the event.

Proposed start date of project *

Must be a date.Must not commence before the program closing date

Anticipated finish date of project *

Must be a date and no later than 30/9/2023.

Key Milestones

Please complete the following table with further details about the stages/phases involved inyour project. Please consider including information on stages relating to:

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• Initiation and design• Construction• Completion

Project stage Start Date End date

Must be a date. Must be a date.

Merit Assessment - Identified Need* indicates a required field

Applications must clearly demonstrate an identified need for the project

Identified need *

Describe why the project is a priority need, what issue does the project address?

Upload evidence or data that backs the need (optional)Attach a file:

Please provide a list of the key user sport clubs by name. E.g. Smithville Football Club,Smithville Cricket Club etc.

Specific key user groups that will benefit from the project: *

Word count:Must be no more than 200 words.

Number of participants *

Must be a number.How many participants will benefit?

What is the longer term benefit to the sport?

What are the expected outcomes of the project? *

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Word count:Must be no more than 100 words.Describe the overall intended outcomes of the project and any strategies that will be used to sustainthe achievements

Merit Assessment - Capacity to Deliver* indicates a required field

Organisation Capacity

Describe the capacity of your organisation to deliver the project *

Describe the capacity of your organisation/project manager to deliver the project by providingexamples of other projects/activities that demonstrate this, or provide governance arrangements (eg.Board structure, sub-committees, working groups, skills and experience of your project manager)

Will you have any project partners in delivering the project? *○ Yes ○ NoEvidence of project partners will be considered as adding to your capacity to deliver the project

Project Partner Details

To add another Project Partner, click on ADD MORE

Project Partner Name *Organisation Name

Contact Name *Title First Name Last Name Email * Must be an email address.

Business Phone *


Role in Partnership *

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Contribution to the project *

Merit Assessment - Budget* indicates a required field

Please complete the following section in order to demonstrate the income sources, andexpenditure required to complete, your project.Prior to doing so please review the following:

• Refer specifically to sections in the Program Guidelines on Eligible projectsand Ineligible projects to ensure your budget only includes eligible scopeitems.

Things to consider when requesting your funding

• Organisations registered for GST: When applying for funding please exclude GSTfrom the amount of funding requested in your project budget. GST will be paid to yourorganisation if successful

• Organisations not registered for GST: When requesting funding for your project,please include GST in the costs for your project budget. Please ensure that quotes youreceive are inclusive of GST that will be charged by trades to deliver the works.

The item costs below must not be included in the application Budget Expenditure

• Staff wages and administration costs• Subsidised registrations for junior players (Active Kids Vouchers are available forjuniors)

• Accommodation, purchase of food and or catering• Appearance fees, prize money and trophies/medals and giveaways• Presentation/celebration functions• Entertainment• Medical equipment or supplies (excluding defibrillators)• Private or commercial ventures• Events that are organised for the primary purpose of fundraising, including charityfundraising events

• Scholarships/sponsorships for individuals• Insurance (public liability, general liability, etc.)• Retrospective funding e.g., projects that have already commenced, completed or goodspurchased prior and up to the advertised closing date of this program

• Purchase or rental of land or premises; vehicles; office equipment (e.g., office furniture,printers, photocopiers etc.)

• Events that are not based in NSW• Subsidy for school sporting activities and events• Supplier discounts used as an applicant contribution

The Budget Expenditure does not include any of the cost items and/or projectcomponents listed above *

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https://www.sport.nsw.gov.au/sites/default/files/2021-09/lsgp_guidelines_2021-22.pdf

https://www.sport.nsw.gov.au/sites/default/files/2021-09/lsgp_guidelines_2021-22.pdf



○ I confirm

Budget Expenditure

You must provide quotes to verify project expenditure which aligns to the informationprovided in your project budget.If you are unable to provide supplier quotes, the following are acceptable alternatives:

• If your provider is an online service, you may provide on online order form with thecost included

• You may provide online screen shots of the items that clearly show the cost.• If there is no other option, you may provide an invoice of a previous service or sale -this document must be clearly noted by the applicant that it is an indicative cost basedon a previous supply or service.

• DO NOT INCLUDE any voluntary labour costs in the budget expenditure

To add another item click on ADD MORE

Item description Item cost Upload quote/s (at leastone quote is required foreach item)

$

Will the project proceed if the full grant amount requested is not approved?○ yes ○ no

Comments relating to the ability tp proceed without full funding (optional) Does your budget include the purchase of a defibrillator? *○ Yes ○ No

1.AEDs – Applicants must rely on their own enquiries as to the suitability of any AEDService Provider they engage.

The provision of an AED package must include:

• An AED• AED familiarisation instruction• A minimum of six years of essential defibrillator maintenance.• Medical Emergency Plan

For further information, please refer to the Program Guidelines

Confirm details noted *○ I confirm

Project Cost

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Total Project Cost$This is the sum of all Item Costs in the table above

Sport Development

Amount Requested (This amount must not exceed the Total Project Cost above) *$Must be a whole dollar amount (no cents) and between 500 and 2000.

Sport Event


Sport Access


Sport Facility


Office use only$

Difference between total project cost and total about requested

Amount Requested must not exceed Total Project Cost

The amount you have requested exceeds your Total Project Cost. Please amendAmount Requested before continuing *○ Noted

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Applicant Financial Contribution

• Applicant Contribution may include other grants and/or financial contributions fromother organisations

• It does not include in-kind contributions, including voluntary labour

Applicant Contribution Amount$Total Project Cost - Amount Requested

Above is the financial amount that the Organisation will contribute to the project*○ Agreed

Do you have any confirmed funding from another grant program and/or anotherorganisation contributing to this project? *○ Yes ○ No

Financial Contribution from another grant program and/or anotherorganisation

Please provide details from another grant program contributing to this project, this does notinclude the amount requested from the Local Sport Grant Program 2021/22 Application

Organisations may only receive State Government funding once for the sameproject or same component of a project from this program or any other NSW StateGovernment grant programClick on ADD MORE if there is more than one contribution to the project

Where is thefunding from?

Scope of funding Amount Confirmed?

$

In-kind Contributions

In-kind contributions are non-monetary contributions of goods and/or services. This mayinclude voluntary labour, donated goods (equipment etc.) and/or services (such as anelectrician donating services to the project).Voluntary labour

Hourly rates should be determined as follows:

Un-skilled labour – no more than $25 per hour

Skilled Labour –trade hourly rate as determined by the award List of Awards

Do you have In-kind contributions for this project? *☐ Voluntary Labour☐ Goods and Services☐ No

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https://www.fairwork.gov.au/awards-and-agreements/awards/list-of-awards


Voluntary Labour and Goods and Services may both be selected if applicable

In-kind Contributions - Voluntary Labour

Click on ADD MORE to add another row

Description No. people No. hours Hourly rate Value $ $

Must be a number. Must be a number. Must be a dollaramount.

This number/amount iscalculated.

In-kind Contributions - Goods and Services

Click on ADD MORE to add another row

Description and quantity Value $

Must be a whole dollar amount (no cents).

Total In-kind Contributions$This number/amount is calculated.

Declaration* indicates a required field

The declaration below must be agreed to by a person who has delegated authority tosign on behalf of the organisation e.g. CEO, General Manager, member of the Board ofManagement or authorised staff member.

I declare that: *☐ I am duly authorised by the organisation to prepare and submit this application.☐ This organisation is eligible to apply for funding in accordance with the eligibility criteriain the Funding Guidelines.☐ The responses in this application and all supporting documents provided are to the bestof my knowledge true and correct.☐ I understand that the Office of Sport may disclose the information provided in thisapplication to other Government agencies, Local Government, reviewers and staff assistingwith the administration or promotion of State Government Grant Schemes and/or in theevent of a request pursuant to the Government Information (Public Access) Act 2009.☐ I understand that information in relation to this project will be made public in the eventthat the application for funding is successful and in other circumstances as outlined in theProgram Guidelines.☐ Where required, our project will comply with all the relevant codes, standards andapplicable legislation of the Australian and NSW Governments.

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☐ I acknowledge that in preparing this application I am not aware of any known conflicts ofinterest as outlined in the Program Guidelines, and will keep the Office of Sport updated ifany conflict of interest arise during the term of the funding agreement.☐ I understand that if the project is successful, the organisation is required to have aminimum Public Liability Insurance cover of $5 million for the duration of the project.☐ The applicant organsation is not named by the National Redress Scheme for InstitutionalChild Sexual Abuse on its list of Institutions that have not joined or signified their intent tojoin the Scheme.At least 9 choices and no more than 9 choices may be selected.



Mobile Phone *



Newsletter

Would you like to subscribe to the Office of Sport Sportshorts newsletter? *○ Yes ○ No

Email Address for newsletter subscription * Must be an email address.

Application Feedback

Please provide us with feedback regarding the online application process so that we cancontinue to improve this for applicants. This section has no impact on the outcome of yourapplication.

Please rate your experience completing this application form: *○ Very easy and simple to complete○ Somewhat easy and simple to complete

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○ Somewhat difficult to complete○ Very difficult to complete

Please estimate how many hours you spent completing this application *

Must be a whole number (no decimal place).

How did you find out about this round of Local Sport Grants Program? *○ Our organisation has applied previously○ Office of Sport newsletter○ Social media (e.g. Facebook, LinkedIn etc)○ Member of Parliament○ Word of mouth

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Local Sport Grant Program 2021/22 Application Form Preview ...

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