ELIGIBILITY DETAILS Is your organisation (or the organisation - PDF document

ARTS NSW CREATION AND/OR PRESENTATION PROJECT FUNDING APPLICATION FORM CLOSING DATE: 5pm, Monday 20 June 2011 1. How to apply Please read the 2012 Arts Funding Program Guidelines before completing this Application Form. To fill in this form on screen, click on the shaded cells to enter data. You can use the tab key to navigate through the form or click on the selected cells. Please complete all parts of the application form. Incomplete applications may be deemed ineligible. Arts NSW encourages applicants to use our online application system (visit: http://apply.arts.nsw.gov.au) to assist with our administrative processes. This is not a requirement and all applications are considered equally. 2. Further information Inquiries related to completing this Application Form should be directed to: Email: arts.funding@communities.nsw.gov.au Freecall: 1800 358 594 (NSW) Telephone: (02) 9228 5533 3. Where to send your application Email address: Hand delivery address Postal address: Arts NSW (business hours only): arts.funding@communities.nsw.gov.au Funding Administration Arts NSW – Reception PO Box A226 Emailed applications will only be accepted Level 9, St James Centre SYDNEY SOUTH NSW 1235 if sent to the above email address. 111 Elizabeth Street SYDNEY NSW 2000 Applications must be received by Arts NSW no later than 5pm, Monday 20 June 2011. Late and/or faxed applications will not be accepted. Application – Page 1 Creation and/or Presentation Project Funding

Applicant name: ELIGIBILITY DETAILS Is your organisation (or the organisation auspicing this Yes No application) legally constituted? (If you answered ‘No’ to the above question, you are inelig ible to apply.) Please identify which of the following best describes your organisation (or the organisation auspicing this application): Not for profit incorporated body Co-operative or trust Local government authority Tertiary education facility (If your organisation or the organisation auspicing this application is not one of the above, you are ineligible to apply.) Application – Page 2 Creation and/or Presentation Project Funding

Applicant name: Part 1: APPLICANT INFORMATION Are you acting as an auspicor* for an individual, partnership, group or unincorporated organisation? Yes No * An auspicor is an incorporated organisation which is the recipient of funding on behalf of an individual, partnership, group or unincorporated organisation, and is responsible for ensuring that the project or activity for which the funds have been granted is completed and the funds are accounted for and acquitted. If ‘Yes’ provide your organisation’s details at 1.1 – 1.4 (as relevant) and the auspicee’s details at 1.5. If ‘No’ provide your organisation’s details at 1.1 – 1.4 (as relevant). 1.1 Applicant details Organisation’s full legal name: Street address of organisation (NOT the address of the Gallery, Museum etc): Postal address (if different from above): Phone: Email address: Website address: Australian Business Number: (If you do not have an ABN, Arts NSW must withhold 48.5% of funds.) Is your organisation registered for GST? Yes No Local Government Area: (Refer to the Glossary and Explanatory Notes document on the Arts NSW website for detail.) Is your organisation required by law to be audited? Yes No Does your organisation report and operate Calendar Year Financial Year on a: Application – Page 3 Creation and/or Presentation Project Funding

Applicant name: 1.2 For business units of local government and tertiary institutions (e.g. museums, galleries) Trading name of business unit : Street address of business unit: Postal address (if different from above): Phone: Email address: Website address: 1.3 Head of organisation (e.g. Chairperson, President, General Manager of local government or tertiary institution) (Note: This person will be notified of the outcome of the application and will be required to sign the Funding Agreement if the application is successful.) Full name (including title): Position held in organisation: Contact phone: Contact email address: 1.4 Contact person for this application: (Note: This person will be notified of the outcome of the application and may be contacted to obtain further information about the application.) Full name (including title): Position held in organisation: Contact phone: Contact email address: Application – Page 4 Creation and/or Presentation Project Funding

Applicant name: 1.5 Details of auspicee (if applicable): The auspicee is an: individual partnership or group unincorporated organisation Full name of individual, partnership / group or unincorporated organisation: Contact name, including title (if applicable): Position held (if applicable): Contact phone: Contact email address: Application – Page 5 Creation and/or Presentation Project Funding

Applicant name: Part 2: PROJECT SUMMARY 2.1 Amount requested from Arts NSW: These two fields will be automatically $ 0.00 populated when you fill in your budget at Part 7. Total estimated cost of the project: $ 0.00 Project start date: Project finish date: (must be between 01/01/2012 and 31/12/2012) This project involves a (select one only): Creative development Public presentation Creative development AND public presentation Complete this sentence to create the title of your project (up to 20 words) : If successful, the funding will be used towards......... (Please DO NOT use first person language such as I or my as this will be used for publicity purposes.) 2.2 Provide a brief description of your project which we can use for publicity purposes if your application is successful (up to 100 words) : (Please DO NOT use first person language such as I or my as this will be used for publicity purposes.) Application – Page 6 Creation and/or Presentation Project Funding

Applicant name: The following questions 2.3 – 2.5 are to collect data for reporting purposes only. (Refer to the Glossary and Explanatory Notes document on the Arts NSW website for detail.) 2.3 What is the main place of activity for this application? (select one only) Central Coast Murray Sydney (excl. Western Sydney) Central West Murrumbidgee Western Sydney Far West North Western Multi-regions Hunter Northern Other (please specify): Illawarra Richmond-Tweed Mid-North Coast South Eastern 2.4 What is the primary type of activity for this applicaton? (select one only) Community Performing Arts Venue (upgrade, Multimedia maintenance and management) partnerships Dance Multi-artforms Physical Theatre and Circus Museum (including Theatre (excluding Physical Theatre and Design Aboriginal keeping places) Circus) Visual arts and craft - Public Gallery Music (excluding Opera and History Music Theatre) Visual arts and craft – Other Literature Opera and Music Theatre Other Venues (Including arts centres, Other Activities community, multipurpose and converged facilities) Please specify: Please specify: 2.5 Does your activity have a specific target audience? If not, you do not need to respond to this question. Audience: Age range: Aboriginal people Children (less than 15 years) CALD (Culturally & Linguistically Diverse) Youth (15 to 24 years) People with a disability Adults (25 to 64 years) Senior Citizens (65 years and over) Application – Page 7 Creation and/or Presentation Project Funding

Applicant name: 2.6 Please provide the estimated additional employment figures that will result from this funding. (Please include estimated employment by organisations other than the applicant if it is a direct result of the funding. For example: venues.) No of people Average no Average no Total employed to of hours of weeks hours deliver this per week per year project per person per person Artist(s) / employee(s) Full time 0 0.00 Part time 0 0.00 Others Casuals 0 0.00 Contractors 0 0.00 Consultants 0 0.00 Volunteers 0 0.00 Application – Page 8 Creation and/or Presentation Project Funding

Applicant name: Part 3: PROJECT INFORMATION Describe your project, including its rationale, location/s and any partnership arrangements. Note: questions regarding key personnel, targeted audience, milestones and performance indicators are included at a later stage of the application. Application – Page 9 Creation and/or Presentation Project Funding

Applicant name: Part 4: AUDIENCE DEVELOPMENT AND PARTICIPATION What is the demand for your project and what strategies are in place (or will you implement) to: build audiences build community engagement build appreciation of your artform/s How will you know if these strategies have been successful? (Refer to Sections 1.2.5 and 1.5 of the 2012 Arts Funding Program Guidelines for further information.) Application – Page 10 Creation and/or Presentation Project Funding