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Please ensure you have read the 'how to apply' section before completing this application.

Please note that we have been experiencing some problems with our application submission process and suggest that you save your text into a word document and then paste this into the fields of our on-line application. If you experience problems in submitting we ask you to please email us at info@haroldmitchellfoundation.com.au and include the error message the system has generated. This will greatly assist us in rectifying the problem.

Note that all fields marked with a * are mandatory fields.
 

Funding Grant Application

Name of Organisation applying for funding*
(individuals making an application should include their name here as well as at the Contact Details section below)
Organisation department/division
If applicable, please include the relevant department or division of the Organisation
 

Organisation CEO/Manager

Please include the name of your Organisation's CEO or Manager
Name
 Title
  
Title in Organisation
 

Organisation Address & Contact Details
(Only complete this section if the organisation undertaking the project is different to the applicant above)
Organisation Name


Organisation Address


ABN
   Contact's Name


Contact's Position Title


Contact's Phone Number


Contact's Email
Is your organisation endorsed as a Deductable Gift Recipient by the ATO?
 

Applicant Address Details

Street*


City*


State*


Postcode* Country*
   Postal Address
If different from address stated at left
Organisation Website
Organisation ABN
Is your organisation endorsed as a Deductable Gift Recipient by the ATO?*
 

Applicant/Primary Contact

Name*
Title *
Title in Organisation
Phone Work*
Phone Home
Mobile
Email Work

Secondary Contact

(if we are not able to make contact with you please provide us with the details of another person we can contact)
Name*
Title*
Title in Organisation
Phone Work*
Mobile
Email Work

Project Details

Application Type  *
Project Title*
Have you undertaken this project before?*
Project Commencement Date
(Known or anticipated)		 (example : 31/01/2008)
Proposed Completion Date
(Known or anticipated)		 (example : 31/01/2008)
Project Description*
Max 1000 words - please be as brief as possible in
describing your project, we will seek further detail if required
Briefly describe how your project fulfills one or more of the Criteria –
'Discovery', 'Capacity' and/or 'Establishment'.*
Project Summary*
Please be as brief as possible and limit your summary to 100 words
If you have applied for full or partial funding or have already received
funding commitments from other sources for this project please detail this
What will the funds you are seeking from the Harold Mitchell Foundation be used for,
and also briefly advise of how you might make up any shortfall of funds.
(Max 100 words)
Amount Sought From Harold Mitchell Foundation ($AUS) *
The latest date by which you need to be
notified of the result of your application*		 (example : 31/01/2008)
* is a mandatory field

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