Item 10.1 - Attachment 3

Fee Subsidy Application Form

 

 

 

 

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Booking Number:

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Contact:††††††††††

††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Telephone:†††††††††† 9806 5140

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† Fax:††††††††††††††† 9806 5927

Dear sir/madam

 

Fee Subsidy Application 2011/2012

 

In response to your request to apply for a fee subsidy for the use of Councilís Public Halls, Community Centres and Meeting Rooms, an application form is enclosed.

 

The estimated hire fee has been entered on the form by Council based on the pre populated bookings on application form you received a few weeks ago.

 

If any of the bookings have changed, you will need to contact Council on 9806 5140 to request an updated hire fee for the 2011/2012 year.

 

It is essential that all sections of the form be completed.Applications that are incomplete will not be considered in the assessment process.

 

The completed form must be returned to Council no later than 1 May 2011.

 

The application is for consideration for a fee subsidy for the 2011-12 financial year only.There will be no guarantee given that the arrangement may continue beyond June 2012.For each subsequent year, applicants will be required to submit a new request for fee subsidy.

 

The assessment will be based on each groupsí contribution to the community and the groups inability to pay full hire charges.The following criteria apply:

 

i.††††††††† The applicant is based within the City of Parramatta and/or principally serves Parramatta residents and is one of the following;

 

(A)†††††† Registered charity

(B)†††††† Seniors group

(C)†††††† Youth organisation

(D)†††††† ATSI organisation

(E)†††††† Womenís group

(F)†††††† Disability Support group

(includes support for persons with medical problems, support groups for smokers, gamblers, alcoholics and persons with drug related problems)

 

Or

 

ii††††††††† The applicant can demonstrate that use of the facility will provide social, community, cultural, medical, artistic, educational or heritage benefit,

 

And

 

iii†††††††† The applicant can demonstrate that;

 

(A)†††††† the costs of the usage can not be recovered from participants and

(B)†††††† the organisation will not profit from the usage and

(C)†††††† the function or activity will not be viable without a subsidy

(D)†††††† the organisation is unable to meet the full cost.

 

Please find enclosed:

 

1.†††††††† A form for the application for fee subsidy for the use of Public Halls, Community Centres and Meeting Rooms.

 

2.†††††††† A reply paid envelope.You may also fax this form to our booking office at 9806 5927 or email the signed form with all required documentation to bookings@parracity.nsw.gov.au.

 

It should also be noted that there might be opportunities for alternate rooms/facilities that may cost less.Please contact the Booking Office on 9806 5140 to discuss this opportunity.

 

Please contact the Booking Office on 9806 5140 if you have any questions or require assistance in completing the form.

 

Yours sincerely

 

Facility Booking Officer

City Culture, Tourism and Recreation


 

APPLICATION FOR FEE SUBSIDY FOR THE USE OF

PUBLIC HALLS AND COMMUNITY CENTRES

2011 to 2012

Date Received:

 

Contact and Group 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, and 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

 

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: