Medium Grant Application Form

Key contact person details

First and last name

Phone number

Email address

Postal address

Tell us about the type of work that you or your group or organisation does? (500 words max)

Project details

What is the name of your project?

How much funding are you applying for? ($1,500 - $3,500)

Provide a high-level budget with a breakdown of the costs of your project (e.g. catering, transport, resources, etc.)

Provide a short description including the purpose of your project (200 words max)

How will your project contribute to:

Your project needs to align with at least one of the priorities above.

Maximum 500 words

What are the time-frames of your project? (When will it start, how long will it last and when will it be completed)

Where will this project take place (location)?

Declaration

You declare and agree that:

You are authorised to act on behalf of your organisation (if applicable)
The information provided in this application form is true and correct to the best of your knowledge
That you will fulfill the requirements as outlined in this form to the best of your abilities
You understand and agree to complete and submit a report about your project within 10 weeks after the completion date. A reporting template will be provided should your application be successful.

I agree to the above terms and conditions and by ticking this box I am electronically signing this form

Yes, I agree and digitally sign this form

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