Western Australia Suicide Prevention Grants Program Application Form

Western Australian Suicide Prevention Grant Program - Application form

Name of person completing this form(Required)

Full Name

Email(Required)

1. About your Organisation

Provide the name of your organisation and where your head office is located. Provide details of the person within your organisation who will be our contact.

Name of Organisation(Required)

What is the legal name of your organisation and where is your head office located?

ABN/ACN(Required)

Address of your organisation (head office)

Street Address Address Line 2 City State Postcode

Name of contact person(Required)

Provide details of the person within your organisation who will be our contact.

First Surname

Position in organisation

Contact Email(Required)

Contact Phone(Required)

Is your project for a priority population?(Required)

Yes, please specify

Priority Population(Required)

If Other, please specify

Is this funding for training, an activity or a defined project?(Required)

Training

Activity

Defined Project

Where in WA will your project be delivered?(Required)

If Other, please specify

How much funding are you applying for?(Required)

NOTE: Grants are for funds up to $100,000 excl GST

Do you hold Public Liability insurance of at least $5 million cover?(Required)

Yes

Will your Organisation be adding any additional funding to the project?(Required)

Yes

If Yes, specify amount

Will your Organisation be adding any in-kind contribution/s to the project?(Required)

Yes

If yes, describe

2. Eligibility Requirements

Is your organisation:(Required)

Incorporated/Not for Profit organisation

a local government authority

an unincorporated organisation or community group

Is your organisation solvent and not under external administration?(Required)

Yes

Have you read and understood the Grant Guidelines including the reporting requirements?(Required)

Yes

Acknowledgment of grant conditions(Required)

I acknowledge that if an offer of grant funding is made to my Organisation, that offer will be subject to the execution of the Grant Agreement and Standard Terms and Conditions.

Yes

Referee details

Please provide details of two referees who we can contact if required

Name 1(Required)

First Surname

Organisation 1(Required)

Position

Email(Required)

Phone(Required)

Name 2(Required)

First Surname

Organisation 2(Required)

Position

Email(Required)

Phone(Required)

3. What is your Organisation's proposed purpose (output) for the grant funding? (40%)

Note: responses must be within the word count

Describe how your Organisation will achieve this purpose (500 words)(Required)

Provide a clear and concise description of what the project and how grant funds will be used. Include how the project is an evidence-based or evidence-informed suicide prevention activity, training or program. How does this relate to the needs of the community? What ongoing supports will be provided to participants?

What are the main Objectives of the project? (300 words)(Required)

How does your project or activity align with the Objective of the grant?

Participants (400 words)(Required)

Provide a clear and concise description of who (targeted group or population) and how the project/activity addresses suicide prevention in WA? How will the applicant ensure the project/activity is culturally appropriate? How will the applicant document consultations, engagement and attendance of the project/activity? How will the applicant receive feedback from the project/activity?

Outputs (500 words)(Required)

Provide a clear and concise description of what the expected outputs will be. Detail how these outputs will be measured and match the objectives of the Western Australian Suicide Prevention Grants Program. Outline if partnering with an Organisation and include a letter of support from that partner Organisation.

Delivery (450 words)(Required)

Provide a clear and concise description of when the outputs are expected to be delivered, including a delivery plan showing how outputs will be achieved as soon as possible of the grant being awarded. Include commencement date, delivery date and project completion date.

Risk Management Plan

Outline the projects risk management plan including how to mitigate the risk. Please use the risk management template provided.

The Risk Management template is available at https://www.suicidepreventionaust.org/wa-grants

Risk Management (template provided)(Required)

Please upload the completed risk management plan using the template provided.

Max. file size: 50 MB.

4. Capability to deliver (30%)

Capability (400 words)(Required)

Provide a clear and concise description of the applicant’s capacity, experience, and capability in delivering the project/activity proposed.

5. Budget / Value for money (30%)

Provide a clear and concise budget plan. Demonstrate that the budget is reasonable, achievable and value for money. Please use the budget plan template provided.

The Budget template is available at https://www.suicidepreventionaust.org/wa-grants

Budget (template provided)

Please upload the budget using the Budget Plan template provided.

Max. file size: 50 MB.

Alternatively, you can download the application form and email the completed application pack to qip@suicidepreventionaust.org

Western Australia Suicide Prevention Grants Program Application Form

Western Australian Suicide Prevention Grant Program - Application form

1. About your Organisation

2. Eligibility Requirements

Referee details

3. What is your Organisation's proposed purpose (output) for the grant funding? (40%)

Risk Management Plan

4. Capability to deliver (30%)

5. Budget / Value for money (30%)

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