applyPlease complete all parts of the form below to submit your application. 1 2 3 4 5 6 7 Essential CriteriaDoes your charity have Donor Gift Recipient (DGR) status?*YesNoDoes your charity hold current registration status with the Australian Charities and Not-for-Profit Commission (ACNC)?*YesNoIs your charity currently up to date with all of its submissions to the ACNC, including the Annual Information Statements and financial statements?*YesNoIs your charity’s governing document (e.g.: constitution) available on the ACNC website, and is it current?*YesNoDo all responsible persons in your organisation hold a current Blue Card, reflecting their potential contact with beneficiaries of your services?*YesNo We're sorry. Based on your answers to the above questions, your organisation is not currently eligible for support. About the ApplicantCompany Details* Company Name ABN Number Contact Name* First Last Address* Street Address Address Line 2 City State Post Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone*Website Answering zero or no to the following questions will not prevent your application from being successful. It will however help us assess the level of maturity of your organisation, the ways in which you operate, and the areas where professional development may be of assistance to you as part of our program if you are successful. What ACNC subtype is your charity registered as?Advancing cultureAdvancing educationAdvancing healthAdvancing natural environmentAdvancing religionAdvancing social or public welfareAdvancing the security or safety of Australia or Australian publicInstitution whose principal activity is to promote the prevention or the control of diseases in human beingsPreventing or relieving suffering of animalsPromote or oppose a change to law, government policy or practicePromoting or protecting human rightsPromoting reconciliation, mutual respect and tolerance between groups of individuals that are in AustraliaPublic benevolent institutionAre all of your responsible persons listed accurately on the ACNC website?YesNoHas the ACNC ever suspended or removed a responsible person associated with your organisation (such as a board member, committee member or trustee) from a charity: either your charity or a charity with which they were previously associated.YesNoHas the ACNC ever suspended or removed a responsible person associated with your organisation (such as a board member, committee member or trustee) from a charity: either your charity or a charity with which they were previously associated.YesNoHas the ACNC ever disqualified a responsible person associated with your organisation (such as a board member, committee member or trustee) from a charity: either your charity or a charity with which they were previously associated.YesNoIs any responsible person currently associated with your organisation (such as a board member, committee member or trustee) or have they ever been: Convicted, and not pardoned, of a crime under the law of Queensland, another State or the Commonwealth; or An undischarged bankrupt under the Bankruptcy Act 1966 (Commonwealth), or a corresponding law of another jurisdiction; or A person who executed a deed of arrangement as debtor under Part X of the Bankruptcy Act 1966 (Commonwealth), or a corresponding law of another jurisdiction, and the terms of the deed have not been fully complied with; or A person who has creditors who have accepted a composition under Part X of the Bankruptcy Act 1966 (Commonwealth), or a corresponding law of another jurisdiction. YesNo The ProjectWhat is the current issue your project will address, and why does it warrant action ?e.g.: 65% of children at xyz school are coming to school without having eaten breakfastAre there any other organisations, nonprofit or commercial, currently performing the service covered in your project, or a service similar to it in the space in which you operate and if so, why is there a need for your project?What action will your project take to specifically address the issues raised above?What are your criteria for/how will you measure success?What help do you need to achieve it?How many children will directly benefit from the proposed initiative?(you may enter a range)How many children will indirectly benefit from the proposed initiative?(you may enter a range) Does the proposal for funding represent:A brand new initiativeThe expansion of an existing successful programThe continuance of a successful program that would otherwise ceaseDo you have other sources of funding for any part of the program?YesNoWhat are the source(s) of the funding?What amount of strategic grant funding are you requesting?How will it be used, and over what timeframe?If your funding application to the Courier Mail Children’s Fund is not successful, what is your back up plan for funding?What plans are in place to achieve media and marketing exposure for your program if funding is secured? Additional Information to Help our Assessment Answering zero or no to the following questions will not prevent your application from being successful. It will however help us assess the level of maturity of your organisation, the ways in which you operate, and the areas where professional development may be of assistance to you as part of our program if you are successful. What number of responsible persons in your organisation, as a whole number and as a percentage of the total number, hold a certification from the Australian Institute of Company Directors, if any?# of persons% of total in organization Does your organisation currently have a plan in place specifically addressing a transition towards advancing financial self-sustainability as part of the overall strategic plan?YesNoIs the organisation investing in the strategic growth, enhancement, development and efficiency of its operations to maximise impact?YesNoPlease provide detailsIs the organisation investing in the strategic growth, enhancement, development and efficiency of its operations to maximise impact?YesNoPlease provide detailsDoes your organisation hold any external quality assurance credentials, such as ISO9001?YesNoDo you have a formal succession plan in place covering your most critical three employment roles?YesNoThe CMCF program includes support with media. Are the individuals and families whose lives will be positively impacted if this funding is approved willing and available for interviews with CMCF staff and the NewsCorp media?YesNoIs a Courier Mail (NewsCorp) staff member endorsing your application? If so please provide their name here. We will contact them and ask them to provide a statement of up to 200 words detailing why they are endorsing your charity, and specifically your proposal for CMCF funding.YesNoName of Courier Mail (NewsCorp) staff member endorsing your application Supporting Information (Optional)Please provide any research or evidence that supports your belief that the project will be successful.Please upload one (1) file, in PDF format no larger than 10MBAccepted file types: pdf.Acknowledgement* I state that all of the information provided in this application is true and correct to the best of my knowledge. Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.
