Regional Jobs and Investment Packages – Skills and training stream Sample application form This document informs you of the questions we will ask you in the online form when you apply for

the Regional Jobs and Investment Packages program. It will help you prepare your responses and

the mandatory attachments you will need before you apply online.

Do not use this document as your application form. You can only submit an application

using the online form when available for your region.

Getting help

If you require assistance preparing your application form please contact us on 13 28 46 or at

business.gov.au. Our website and staff can help you with forms (once available), finding business

information and services and allow you to provide feedback, comments or suggestions.

You should also read and understand the program guidelines and sample grant agreements before

completing an application. View these documents at business.gov.au.

Submitting your application

Applications must be submitted using the online form which will be available when your region’s

Local Investment Plan is published.

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A. Eligibility

A.1. Eligible entities

This section will help you determine whether you are an entity eligible for the Skills and training

stream of the program.

You are required to answer all questions in this section.

Is your organisation a local government agency or body?

A local governing body as defined in the Local Government (Financial

Assistance) Act 1995 (Cth).

yes no

Is your organisation a not for profit organisation that is a legal entity and has

been established for at least two years)?

You must demonstrate your not-for-profit status through one of the following:

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

registration

state or territory incorporated association status

other evidence such as constitutional documents and/or articles of

association.

yes no

If you answered ‘yes’ to either of these question above you are eligible to apply for this program.

A.2. Additional eligibility criteria

This section will help you determine whether you comply with additional eligibility criteria for the

Skills and training stream of the program.

You can confirm the RJIP region boundaries by referring to the map in Appendix D of the program

guidelines.

You are required to answer all questions in this section.

Will your proposed project provide benefit to an identified RJIP region? yes no

Does your organisation have an ABN? yes no

Does your project involve training, professional development or education

programs delivered to eligible learners other than your employees?

yes no

Do you have approval from your board (or support from the owner or chief

executive officer if there is no board) that the project is supported and that you

can complete the project and meet the costs of the project not covered by

grant funding?

Evidence of the approval will need to be attached to the application

yes no

If you answered ‘yes’ to all of the questions above you are eligible to apply for this program.

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For further information regarding eligibility requirement for this program refer to the Regional Jobs

and Investment Packages program guidelines.

A.3. Exceptional circumstances co-funding exemption

You may apply for an exemption to the co-funding requirement if your meet exceptional

circumstances. Before you consider seeking an exemption note

exemptions will only be granted in rare circumstances

if an exemption is not granted your application will be ineligible and there will be no opportunity

to resubmit your application in the same funding round

all applications, including those granted an exemption, will be assessed against each of the

merit criteria. Applications with reduced or no co-funding may receive a lower score against the

‘value for money’ criterion (merit criterion 3)

you are encouraged to leverage cash contributions, community partnerships and in-kind

contributions, even if you seek an exemption, to strengthen your application and increase your

score against the ‘value for money’ criterion

to be competitive, your application will need to score highly against all merit criteria, and

contribute toward the program’s outcomes.

If your case for exemption due to exceptional circumstances is not granted your application is

deemed ineligible.

Are you applying for an increased grant percentage under exceptional

circumstances?

yes no

Which of the following apply to your case for exceptional circumstances?

drought and/ or disaster declaration

limited financial capacity of the local council

impact of industry decline

significant recent change in population or community demographics

Provide a supporting case which includes evidence demonstrating the exceptional circumstances

you are experiencing and how they prevent you from your meeting the standard co-funding

requirement.

TBA word limit

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B. Applicant information

B.1. Joint applications

Joint applications are acceptable, provided you have a lead applicant who is the main driver of the

project and is eligible to apply.

Is this a joint application? yes no

If you answered ‘yes’ to this question the lead applicant must complete this form. If you are unsure

of the status of your application as a joint application please contact us on 13 28 46 or at

business.gov.au

B.2. Type of applicant

Select which type of entity your organisation is

If you selected not for profit, how will you demonstrate your not-for-profit status?

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

state or territory incorporated association status

other evidence such as constitutional documents and/ or articles of association

Where you select other evidence you will need to attach this evidence in the form.

Are you also an incorporated trustee on behalf of a trust? yes no

B.3. Applicant details

If you are applying as a trustee on behalf of a trust leave this question blank and go to the next

question.

Australian Business Number (ABN)

Australian Company Number (ACN)

If applicable

Legal/ registered entity name

Business/ trading name

Your business may have registered one or more

business names. If you operate under a business or

trading name enter alternate names here.

a local government agency or body.

a not for profit organisation that has been established for at least two years

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GST registered? yes no

B.4. Trustee and trust details

Australian Business Number (ABN) of the trustee

(if different to trust, otherwise leave blank)

Australian Company Number (ACN) of the trustee

Legal/ registered entity name of the trustee

Australian Business Number (ABN) of the trust

Legal/ registered entity name of the trust

Business/ trading name

Your business may have registered one or more

business names. If you operate under a business or

trading name enter alternate names here.

Is the trust GST registered? yes no

You must provide a copy of the trust documents showing the relationship of the incorporated

trustee to the trust.

B.5. ANZSIC details

What is the applicant’s main revenue earning activity

under the Australian and New Zealand Standard

Industrial Classification (ANZSIC)?

The ANZSIC codes and titles are available from the

Australian Bureau of Statistics (ABS) website. Phone

13 28 46 if you require assistance.

B.6. Address details

Provide your Organisation’s Street Address (Australian Head Office).

Address

Suburb/ town

State/ territory

Postcode

Provide your Organisation’s Postal Address.

Same as your organisation street address, go to next section.

Different to your organisation street address, provide details below.

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Address

Suburb/ town

State/ territory

Postcode

Country Australia

B.7. Website address

Provide your organisation’s website address.

B.8. Project site address

Will your project’s activities occur solely at the above listed head office

address?

yes no

If you answered ‘yes’ go the next question. If you answered ‘no’ complete the following table.

Project site address must be a street address not postal.

Site address 1

Address

Suburb/ town

State/ territory

Postcode

Country Australia

Site address 2

Address

Suburb/ town

State/ territory

Postcode

Country Australia

Site address 3

Address

Suburb/ town

State/ territory

Postcode

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Country Australia

B.9. Latest financial year figures

Has the applicant existed for a complete financial year? yes no

If you answered ‘yes’, enter the latest completed financial year, then complete

the table below.

Example entry 2015-16

If you answered ‘no’, enter the number of months completed in financial year

to date, then complete the table below.

months

We collect the following data from all applicants across all grant programs. We use this data to

better understand your organisation and to help us develop better policies and programs.

All amounts in the table below must show a whole dollar value e.g. $1 million should be presented

as $1,000,000. The turnover value must be that of the incorporated entity that is making the grant

application (the ‘applicant’), regardless of whether the entity belongs to a consolidated group for tax

purposes.

These fields are mandatory and entering $0 is acceptable if applicable. If they clearly do not apply

to your organisation you may select not applicable.

Recent trading performance Check box if the

indicator not

applicable to your

organisation

Latest financial

year figures

Sales revenue (turnover)

Total revenue from the sale of goods and services, as

reported in the applicant’s Business Activity Statement

(BAS).

n/a $

Export revenue

Total revenue from export sales, as reported in the

applicant’s Business Activity Statement (BAS).

n/a $

R&D expenditure

Expenditure on Research and Development, i.e.

creative work undertaken on a systematic basis in

order to increase the stock of knowledge, including

knowledge of man, culture and society, and the use of

this stock of knowledge to devise new applications.

n/a $

Taxable income

Taxable income or loss as per the applicant’s business

income company tax return form.

n/a $

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Recent trading performance Check box if the

indicator not

applicable to your

organisation

Latest financial

year figures

Employees, including working proprietors and salaried

directors (headcount)

No of individuals who are entitled to paid leave (sick

and holiday), or generate income from managing the

business.

n/a

Independent contractors (headcount)

No of individuals engaged by the business under a

commercial contract (rather than an employment

contract) to provide employee-like services on site.

n/a

B.10. Project partner organisation details

If in the first question of this section you answered ‘yes’ to the question relating to joint applications

you are required to provide details of the joint project partner organisations in the following table.

For an explanation of entity types refer to the second question. You may be required to provide

further financial details about your collaborative project partners if your application is successful.

No Australian Business

Number

Australian Company

Number

Organisation name Entity type

1

2

3

4

You must attach a letter of support from each of the other organisations involved in the proposal.

Refer to section 11.2 of the program guidelines for what is required in the letter of support.

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C. Project details and funding

C.1. Project title and description

If your application is successful, some project details you provide will be published on the

Department of Infrastructure and Regional Development website and GrantConnect. Published

project details include:

name of the applicant

title of the project

a description of the project and its intended outcomes

amount of funding awarded.

Provide a project title.

Example project title: Training and development in world class advanced manufacturing

25 word limit

Provide a brief project description for publication on our website.

Ensure your project description focuses on your project’s key activities and outcomes. Explain what

it is you are going to do and how it will benefit the region. If the application is successful this project

description will be used by the Australian Government in published material.

Example project description: A tailored skills and training program to assist learners in advancing

their manufacturing and technology knowledge and skills to benefit regional areas.

125 word limit

C.2. Summary of activities and outcomes

Provide a summary of your project, including the key activities and project outcomes.

225 word limit

C.3. Project participation

How many people will be directly impacted by your skills and training activity?

C.4. Project plan

You must provide a plan of the project activities you will conduct.

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A strong project plan should include the following

scope

implementation methodology

timetable

budget and cost estimates for all significant activities

status of relevant approvals.

You should include this as attachment when submitting your application.

C.5. Project milestones and key activities.

Provide details on the activities occurring at each milestone.

The start date of milestone 1 is the expected project start date. The end date of your last milestone

activity will be the project end date.

Milestone 1

Milestone title

Milestone description

Milestone start date Milestone end date

Milestone 2

Milestone title

Milestone description

Milestone start date Milestone end date

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Milestone 3

Milestone title

Milestone description

Milestone start date Milestone end date

C.6. Project duration

Project start date Project end date

C.7. Project budget

Provide details on your project costs over the life of the project including both eligible and ineligible

costs.

Amounts must be GST exclusive. We only provide grant funding based on eligible expenditure.

Refer to the program guidelines for guidance on eligible expenditure.

Cost item FY

2017-18

FY

2018-19

FY

2019-20

Total

Labour $ $ $ $

Materials $ $ $ $

Plant and equipment $ $ $ $

Information technology $ $ $ $

External consultants $ $ $ $

Other $ $ $ $

Subtotal eligible expenditure $ $ $ $

Ineligible

costs $ $ $ $

Total project costs $ $ $ $

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If your application is successful you will be required to provide documents to support estimated

project costs before your grant agreement is finalised. Examples of supporting documents are

equipment supplier quotes, contractor quotes, etc.

C.8. Source of funding

Complete the table below to show how you will fund the eligible project costs.

Amounts must be GST exclusive.

Contributions from a partner organisation or other non-government sources are considered an

‘applicant’ contribution.

a. Applicant's contribution ($A) $

b. Program grant amount ($A) $

c. Other Commonwealth Government funding ($A) $

d. Other (non-Commonwealth) government funding ($A) $

Total eligible project costs ($A) $

Grant percentage (%) (Cannot exceed 50%) %

Total Commonwealth Government grant percentage (%) (Cannot exceed 50%) %

No more than 50 per cent of your total eligible project costs can be funded from Commonwealth

grants unless you are seeking an exceptional circumstances co-funding exemption.

If you are receiving other government funding as indicated in the table above, provide details of the

other government grant funding.

Program name Funding amount

$

$

Total $

C.9. Your contribution

To describe your funding strategy for the project complete the table below and provide the following

attachments.

Fund type Amount ($A) Description on the source of funding

Cash flow $

Loans $

Equity $

Funding contributor $

Other $

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Fund type Amount ($A) Description on the source of funding

Total $

You must also attach the following:

evidence of conditional support from your board (or if there is no board, support from the owner or chief executive officer) that the project is supported, and that you can complete the project and meet the costs of the project not covered by grant funding.

an accountant declaration to confirm your organisation can fund its share of the project costs. You must use the template provided on business.gov.au.

evidence of funding commitment from other funding contributors (if applicable)

.

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D. Merit criteria

To be competitive you will need to score highly against each merit criterion. Your application will be

assessed against the indicators listed beneath each merit criterion. The merit criteria are weighted

as indicated by the points. The amount of detail and supporting evidence you provide should be

commensurate with the project size, complexity and grant amount requested. You should define,

quantify and provide evidence to support your answers.

You may attach any other documents that support your application and/or claims made in relation

to the merit criteria.

D.1. Merit criterion 1 (20 points)

The extent to which your project addresses the Local Investment Plan’s investment sectors

and strategic priorities.

You may demonstrate this through identifying how your project aligns with

a. investment sectors identified in the plan

b. the strategic priorities in the plan - for example by unlocking further investment, reaching

new markets or creating sustainable employment.

5000 characters

Merit criterion 2 (30 points)

The level of net economic benefit your project will deliver to the region during and beyond

the project period.

You may demonstrate this through identifying

a. the extent to which your project will support local employment, for example by upskilling

employees and job seekers in new and emerging growth sectors

b. how many people will benefit directly from your training and skills project, for example how

many new training opportunities will be made available

c. the need for the training for a particular skill or expertise and the strategy to source training

candidates

d. how the project will assist workers affected by structural adjustment to retrain and gain

employment in new and emerging growth sectors

e. how the training will increase the capability and technical expertise of the local workforce

f. how the project will enable the regional workforce to better meet demand from employers

and build competitiveness

g. how the project will increase opportunities for Indigenous economic participation

5000 characters

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D.2. Merit Criterion 3 (30 points)

The value for money offered by your project.

a. the likelihood of the project going ahead without the grant funding. Explain how the grant will

impact the project in terms of size, timing and reach if applicable.

b. the expected return on investment for the project (including details about the projected return

relative to the grant amount invested into the project)

c. the extent to which the project leverages additional partnerships, cash or in-kind

contributions from other organisations

d. the extent to which the project leverages additional cash contributions beyond the mandatory

50 per cent.

5000 characters

D.3. Merit Criterion 4 (20 Points)

Your capacity, capability and resources to carry out the project.

You may demonstrate this through identifying

a. your track record with similar projects

b. your access to personnel with the right skills and experience

c. your readiness to commence the project with appropriate approvals planned for or in place

d. details in your project plan which include

key risks

identifying key milestones

project budget

how you will manage project dependencies for example sourcing key resources and

approval from issuing authorities

5000 characters

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E. Contact details

E.1. Details of primary contact

Person authorised to act on behalf of the applicant.

(Note: You must provide at least one phone or mobile number. Other than title, all the remaining

fields below are mandatory unless stated otherwise.)

Provide details of the primary contact.

Title

Given name

Family name

Position title

Phone number

Mobile number

Email address

Provide the postal address of the primary contact

Address

Suburb/ town

State/ territory

Postcode

Country Australia

E.2. Contact’s relationship to applicant

Is the applicant the primary contact’s employer? yes no

If you answered ‘yes’ go the next question. If you answered ‘no’ complete the following table.

What is the relationship of the primary

contact to the applicant?

Name of primary contact’s employer

Australian Business Number (ABN) of

primary contact’s employer

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Provide a contact for the applicant organisation

Title

Given name

Family name

Position title

Phone number

Mobile number

Email address

E.3. How did the applicant hear about the program?

--- Please select ---

If Other, please specify:

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F. Applicant declaration

F.1. Privacy and confidentiality provisions

I acknowledge that this is an Australian Government program and that the department will use the

information I provide in accordance with the following:

Australian Government Public Data Policy Statement,

Commonwealth Grants Rules and Guidelines,

Program guidelines

applicable Australian laws.

Accordingly, I understand that the department may:

a. share information in this application with other government agencies for any purposes,

including government administration, research or service delivery; and

b. publish non – sensitive information in this application in the public domain, including on the

department’s website;

unless otherwise prohibited by law.

I confirm that I have read and understood the privacy, confidentiality and disclosure provisions

outlined in the program guidelines

By checking this box I agree to all of the above declarations and confirm all of the above

statements to be true

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F.2. Applicant declaration

I declare that I have read and understood the program guidelines.

I declare that the proposed project outlined in this application and any associated expenditure has

been endorsed by the applicant’s board or person with authority to commit the applicant to this

project.

I declare that the information contained in this application together with any statement provided is,

to the best of my knowledge, true, accurate and complete. I also understand that giving of false or

misleading information is a serious offence under the Criminal Code 1995 (Cth).

I declare that the applicant will comply with, and require that its subcontractors and independent

contractors comply with, all applicable laws.

I understand that I may be requested to provide further clarification or documentation to verify the

information supplied in this form and that the department may, during the application process,

consult with other government agencies, including state and territory government agencies, about

the applicant’s claims and may also engage external technical or financial advisors to advise on

information provided in the application.

I acknowledge that if the department is satisfied that any statement made in an application is

incorrect, incomplete, false or misleading the department may, at its absolute discretion, take

appropriate action. I note such action may include excluding an application from further

consideration; withdrawing an offer of funding; using the information contained in the application for

a fraud investigation that would be consistent with the Australian Government’s Investigations

Standard and Fraud Control Guidelines and for management purposes and/or terminating any

grant agreement between the Commonwealth and the recipient including recovering funds already

paid.

I agree to participate in the periodic evaluation of the services undertaken by the department.

I declare that I am authorised to complete this form and to sign and submit this declaration on

behalf of the applicant.

I approve of the information in this application being communicated to the department in electronic

form.

By checking this box I agree to all of the above declarations and confirm all of the above

statements to be true

By including my name in this application it is deemed to be my signature for the purpose

of this application

F.3. Signature

Name of signatory

Email address of signatory

Date

Signature