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 Council’s 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 groups’ 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
(A) Registered charity
(B) Seniors group
(C) Youth organisation
(D) ATSI organisation
(E) Women’s 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: |
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Contact and Group Name: |
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Contact Phone Number: |
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Postal Address: |
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(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: |
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Is your organisation registered for GST? If Yes,
please list details: |
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Is your organisation based within the City of |
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Does your organisation use the facility to provide social, community,
cultural, medical, artistic, and educational or heritage benefit? Please list details: |
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What income does your organisation receive annually? |
Amount ($) |
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Membership Fees |
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Attendance Fees (e.g. weekly contributions) |
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Donations |
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Sponsorship |
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Grants |
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Fundraising for Organisation (inc. raffle income) |
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Fundraising for Charity |
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Ticket Sales / Door Takings |
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Other Income |
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TOTAL ANNUAL INCOME |
$ |
What expenditure items does your organisation incur annually? |
Amount ($) |
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Instructors/Coaches/Other Staff |
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Insurance |
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Administration (Telephone, Postage, Stationery) |
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Affiliation/Association Fees |
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Equipment Hire/Purchase |
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Materials-Consumables Hire/Purchase |
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Other Costs (Please specify) |
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Facility Hire Costs |
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TOTAL ANNUAL EXPENDITURE |
$ |
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Does your organisation generate profit? If Yes, please list details (including amount and destination of
profit): |
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ANNUAL PROFIT = INCOME - EXPENDITURE |
$ |
(Please attach additional pages if there is
insufficient room to provide all details) |
Yes |
No |
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Does your organisation hold a bank account? |
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Amount |
$ |
Date |
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If yes, is any of this money committed to a specific purpose (other
than annual operating costs)? If yes, please list details: |
Amount ($) |
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(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: |
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If your organisation did not receive a subsidy, would its operation
remain viable? Please list details: |
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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 organisation’s eligibility for a fee subsidy? |
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Please attach the following documents (If not available, please
indicate why) |
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Constitution |
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Registration as a Charity |
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Most recent Annual Report |
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Most recent Annual General Meeting Minutes |
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Most recent Financial Statement |
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Proof of not-for-profit status |
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Please list any other documents that you have provided to support your
application. |
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I hereby certify that the information provided in
this application is true and correct. I undertake to advise I agree to state any financial assistance provided
by |
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Signature: |
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Date: |
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