Application Form

NAIDOC Week Grants for Smaller Communities 2025

Western NSW Primary Health Network (WNSW PHN) is offering one-off community grants to support NAIDOC Week celebrations across regions with populations under 16,000 people. This initiative aims to strengthen relationships with stakeholders and Aboriginal communities by supporting locally led activities that celebrate the history, culture, and achievements of Aboriginal and Torres Strait Islander peoples.

Applications will remain open until 5:00pm, Friday 18 July 2025.

Applicants are required to read the Grant Guidance 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 up to $ 500/- (excluding GST) is available per application.

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 *

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) *

An Aboriginal organisation or business with an Australian Business Number (ABN). A NAIDOC Committee without an ABN that is auspiced by an organisation with an ABN.A NAIDOC Committee that is not incorporated but has a formal agreement with an eligible incorporated organisation to auspice the funding.A non-Aboriginal entity with a letter of endorsement from an Aboriginal Community Group or Aboriginal Community Controlled Organisation.

A non-Aboriginal entity should attach a letter of endorsement from an Aboriginal Community Group or an Aboriginal Community Controlled Organisation.

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

YesNo

Proposed NAIDOC Week celebrations will be conducted in a location within the Western NSW PHN region. *

YesNo

Details of Proposed Activities

Please describe your proposed NAIDOC Week event or activities. *

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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Name *

Position *

Date: *

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