Item 11.2 - Attachment 1

Attachment 1 - Fee Subsidy - Application Form

 

 

APPLICATION FOR FEE SUBSIDY FOR THE USE OF

PUBLIC HALLS AND COMMUNITY CENTRES

- Annual Hirers††† 2010 - 2011

Date Received:

 

Organisation Name:

 

Contact Name:

 

Contact Phone Number:

 

Postal Address:

 

 

(Please attach additional pages if there is insufficient room to provide all details)

Yes

No

Does your organisation have an ABN Number? If Yes, please list details:

 

 

___ \ ___ \ ___ \ ___ \ ___ \ ___ \ ___ \ ___ \ ___

Is your organisation registered for GST? If Yes, please list details:

 

 

 

Is your organisation based within the City of Parramatta and/or principally serves Parramatta residents?Please list details:

 

 

 

 

Does your organisation use the facility to provide social, community, cultural, medical, artistic, educational or heritage benefit?

Please list details:

 

 

 

 

 

 

What income does your organisation receive annually?

Amount ($)

Membership Fees

 

Attendance Fees (e.g. weekly contributions)

 

Donations

 

Sponsorship

 

Grants

 

Fundraising for Organisation (inc. raffle income)

 

Fundraising for Charity

 

Ticket Sales / Door Takings

 

Sale of Goods

 

Other Income

 

 

 

 

 

 

 

TOTAL ANNUAL INCOME

$


 

What expenditure items does your organisation incur annually?

Amount ($)

Instructors/Coaches/Other Staff

 

Insurance

 

Administration (Telephone, Postage, Stationery)

 

Affiliation/Association Fees

 

Equipment Hire/Purchase

 

Materials-Consumables Hire/Purchase

 

Other Costs (Please specify)

 

 

 

 

 

 

 

Facility Hire Costs

Filled in by Booking Office

TOTAL ANNUAL EXPENDITURE

$

Does your organisation generate profit?

If Yes, please list details (including amount and destination of profit):

 

 

 

 

ANNUAL PROFIT = INCOME - EXPENDITURE

$

 

(Please attach additional pages if there is insufficient room to provide all details)

Yes

No

Does your organisation hold a bank account?

 

 

 

Amount

$

Date

 

If yes, is any of this money committed to a specific purpose (other than annual operating costs)? If yes, please list details:

Amount ($)

 

 

 

 

 

 

 

(Please attach additional pages if there is insufficient room to provide all details)

Yes

No

Is your organisation able to meet the full cost of its activities?

Please list details:

 

 

 

 

If your organisation did not receive a subsidy, would its operation remain viable? Please list details:

 

 

 

 

What level of subsidy does your organisation request?

$


 

Is there any other information that you believe Council should know that might assist in determining your organisationís eligibility for a fee subsidy?

 

 

 

 

 

 

 

 

Please attach the following documents (If not available, please indicate why)

Constitution

 

Registration as a Charity

 

Most recent Annual Report

 

Most recent Annual General Meeting Minutes

 

Most recent Financial Statement

 

Proof of not-for-profit status

 

Please list any other documents that you have provided to support your application.

 

 

 

 

 

 

I hereby certify that the information provided in this application is true and correct.

I undertake to advise Parramatta City Council should there be any variation or alterations to these information supplied immediately.

I agree to state any financial assistance provided by Parramatta City Council in any subsequent requests for funding for fee relief or otherwise.

Signature:

 

Date: