Application Form

Multicultural Grants Program Grant

The Multicultural Community Grants Program supports local not‑for‑profit organisations to deliver small, community‑led activities that strengthen wellbeing, social connection, and access to primary care for Culturally and Linguistically Diverse (CALD) communities across Western NSW.

Funded activities must be non‑clinical, culturally appropriate, and locally relevant, with a focus on improving mental health and wellbeing, reducing access barriers, and strengthening community connection through inclusive, in‑language or community‑designed initiatives.

Applications will remain open until funds exhausted.

Applicants are required to read the Grant Guidelines before applying. Submission of a signed online application does not guarantee funding. WNSW PHN reserves the right to request changes to the proposed activity prior to approval.

Funding of up to $10,000 (excluding GST) is available per eligible organisation. All funded activities must be completed by 30 June 2026.

APPLICATION DETAILS

Legal Name of Organisation: *

Trading Name of Applicant (if applicable):

Do you have an ABN? *

Yes No

ABN: *

Are you registered for GST? *

YesNo

If Other, please specify *

Street address *Street address line 2

City *

State *

Postcode *

Briefly describe your organisation (no more than one paragraph) *

APPLICATION CONTACT DETAILS

In this section you are asked to provide contact details of your organisation's authorising officer and/or key contact person for this application. The authorised contact person is the person who is authorised to sign a funding agreement on behalf of your organisation, should your application be successful.

Authorised Person’s name: *

Authorised Person's Position title: *

Authorised Person's Email Address *

Authorised Person's Phone number *

The application contact should be the person we will contact for any issues related to the application and project activity:

Application contact person: *

Application contact person position title: *

Contact Person's Email Address *

Contact Person's Phone number: *

ELIGIBILITY CRITERIA

Does your organisation meet one or more of the following eligibility criteria? (Mark all that apply) *

Our organisation is a not‑for‑profit organisation (including sporting clubs, community groups, early childhood services or schools) and holds a current ABNOur organisation currently engages with CALD communities or has a clear partnership with a trusted CALD or multicultural organisation.Our organisation is able to commence activities promptly and complete delivery by 30 June 2026.Our organisation is located within the Western NSW PHN region.The proposed activity will be delivered within communities in the Western NSW PHN region, with priority locations including Dubbo, Orange and Bathurst.The proposed activity will be delivered at no cost to community participants.Primary health care practitioners.An Aboriginal Community Controlled Health Organisation (ACCHO).Community group without an ABN applying under auspice arrangements.

Holds Public Liability Insurance (minimum coverage $10 million) *

YesNo

Location of the organisation. *

DubboOrangeBathurstOther

If "Other" please provide the location. *

Details of Proposed Activities

1.Please briefly describe your proposed activity and how it supports CALD community wellbeing and/or access to primary care services in Western NSW - Weight: 20 *

2. Which CALD community or communities will benefit from this activity, and what local need or issue does it address? - Weight: 20 *

3. What activities will you deliver, and what outcomes do you expect for participants or the community?- Weight: 20 *

4. Please explain how the requested funding will be used and why the proposed costs represent good value for money. - Weight: 20 *

5.Please outline your organisation’s experience, capability, or partnerships that will support successful delivery of this activity by 30 June 2026. - Weight: 20 *

ACTIVITY BUDGET

Please provide a breakdown on how you intend to utilise the funds.

Expense Type *

Description of expenses *

Budgeted Amount (excl GST) *

Total Amount Budgeted $ (excl GST) *

DECLARATION

This section must be completed by an authorised representative of the organisation submitting the application.

I declare that:

I confirm the contents of this application are to the best of my knowledge accurate, complete and do not contain any false, misleading, or deceptive misrepresentation, claims or statements. *

I have read, understood, and agree to the Grant Guidelines, should this application be successful. *

I declare that the organisation is financially viable and able to manage the funding within the timeframe and within budget. *

I understand that the evaluation decision is final, and no correspondence will be entered into. *

I understand and accept that information provided in this application will be stored by WNSW PHN in various formats, including hard copy and or electronic. *

I confirm that this application does not duplicate existing funding, service delivery or ongoing operational costs. *

I agree to contact WNSW PHN should I become aware of any changes to information contained in this application. *

I understand that this application does not create a legal or binding commitment. *

If the application is successful, I acknowledge that:
- The organisation will be asked to sign a Grant Agreement with the WNSW PHN;
- The organisation will be asked to sign a statement stating they have used the funds in accordance with their application;
- The organisation will provide reports to the WNSW PHN in accordance with their grant agreement; and
- The organisation agrees to maintain adequate insurance for the duration of this grant agreement and provide WNSW PHN with proof when requested. *

I understand if the conditions of the funding are not complied with:
- The WNSW PHN will recover the funds allocated; and
- The WNSW PHN may terminate the grant agreement with the applicant. *

I have read the WNSW PHN General Grant Conditions *

Applicant Signature *

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Please complete the CAPTCHA challenge below to verify that this submission is being made by a human applicant. * *

Name *

Position *

Date: *

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