Criminal Property Confiscation Grants Program … · Web viewOffice use only Application no: Date...

Criminal Property Confiscation Grants Program (CPCGP)Round 15

Dear Applicant

Thank you for your interest in the Criminal Property Confiscation Grants Program.

Grants may be made to not-for-profit organisations or local governments for the purposes prescribed in Section 131(2) of the Criminal Property Confiscation Act 2000 (the Act), including:

the development and administration of programs or activities designed to prevent or reduce drug-related criminal activity and the abuse of prohibited drugs

the provision of support services and other assistance to victims of crime for any other purpose in aid of law enforcement.

Please read the Criminal Property Confiscation Grants Program Application Guidelines before you complete this form. Applications will only be accepted on this form. Please do not alter the order of the material or format of the application; or staple / bind your application and accompanying documents. Incomplete or late applications or requests for extensions will not be accepted.

If you require any assistance to complete the form, please contact a member of the grants team on (08) 9264 1206 or (08) 9264 1749.

Country callers can call toll free on 1800 994 400.

You can mail your completed application and accompanying documents to:

Criminal Property Confiscation Grants ProgramDepartment of JusticeGPO Box F317PERTH WA 6841

or

Email to [email protected]

Incomplete applications or applications received after the advertised closing date of12 noon on Wednesday 1 April 2020 will be ineligible for consideration.

Criminal Property Confiscation Grants Program (CPCGP) – February 2020 of 15

mailto:[email protected]

Office use onlyApplication no:Date received:

Criminal Property Confiscation Grants ProgramApplication formAll sections of this form must be completed. Please do not alter the sequence of the information requested.

1 Section 1 – Applicant Information

1.1 Name of your organisation:

1.2 Name of project:

1.3 Proposed project term (including start and end dates):

(Project must run for a minimum of 12 months to a maximum term of two (2) years. Please nominate a start date no earlier than six (6) months after closing date for applications.

1.4 Geographical area served by organisation:

Regional area: Local Government area: Town: Metropolitan suburb:

1.5 Geographical area served by project:

Regional area: Local Government area: Town: Metropolitan suburb:

1.6 Is your organisation an incorporated not-for-profit organisation? Yes No

1.7 Date of Incorporation:

(Attach copy of your organisation’s Certificate of Incorporation)

Total CPCGP funding requested: $

(Note: Do not include GST. Funding is limited to $200,000 per grant)


2 Section 2 – Applicant details

2.1 Details of applicant organisation:

Street address:

Postal address:

2.2 Your organisation’s contact person for this project:

Title: Mr Mrs Ms Dr

Name:

Position title:

Phone: Mobile: Fax:

Email:

2.3 Name of your organisation’s office holder (President, Chairperson, CEO or equivalent) accepting responsibility for the project and the funding:

Title: Mr Mrs Ms Dr

Name:

Position title:

Phone: Mobile: Fax:

Email:

2.4 Does your organisation have an ABN?: Yes No If yes, please provide your ABN:

2.5 GST registered? Yes No

2.6 Website address (if available):

2.7 Please describe the aims and activities of your organisation:


3 Section 3 – Proposed Project

3.1 Which of the following criteria will your project address?

You may tick more than one box.

The development and administration of programs or activities designed to prevent or reduce drug-related criminal activity and the abuse of prohibited drugs

The provision of support services and other assistance to victims of crime.

Any other purpose in aid of law enforcement which focuses on community safety and crime prevention initiatives within Western Australia.

3.2 Provide a detailed description of the purpose, goal or issue to be addressed by the proposed project?

3.3 Who are the target or population groups for this project? How many individuals are expected to benefit from this project?

3.4 Is the proposed project a new initiative? Yes No

3.5 Is the purpose of the funding for an existing project? If yes, provide details: Yes No

3.6 Can you provide an example that demonstrates your organisation’s ability/ capacity to manage the implementation and financial aspects of the project and meet the reporting requirements of this grant.Yes No

If yes, provide details.

3.7 How will this project meet community needs? Include supporting evidence such as research, statistics, demographics and any other indicators.

3.8 Does the proposed project provide a service currently available through another community or Government agency? Yes No

If yes, provide details.


3.9 Please provide details of your project work plan including proposed timeframes. You will be required to report against these outcomes.

Proposed Activity / Time frame for commencement and completion

Outcomes – What do you want to achieve from this activity?

Performance Measures – How will you measure the success of this activity?


3.10 Please provide an outline of milestones and proposed completion dates to mark significant events in your project plan. Include six-monthly reporting dates as these are directly linked to grant payments throughout the term of the project.

Milestones Proposed completion date

(For example) Grant Agreement finalised; submit first progress report to Department of Justice; premises leased; appointment of relevant staff etc

Date / month / year


4 Section 4 – Budget

4.1 Have you previously received funding from the Criminal Property Confiscation Grants Program? Yes No

If yes, please provide details, including the purpose of the project(s):

Project name:Amount of funding received: $ Project Term:

Purpose of project:


Purpose of project:


Purpose of project:

4.2 Please provide details of consultations undertaken with relevant community groups and organisations. Indicate if any of these groups will be involved in the development and conduct of this project.

Provide evidence demonstrating support for this project (for example, letters of support and/or contribution to the proposed project).

Organisation Name Contact number

4.3 Is there a requirement for insurance cover of any description for this project? (ie Worker’s compensation, personal accident, public liability).Yes No


If yes, please provide details of current insurance cover required or already provided under your organisation’s policy.

If no, please state why insurance cover is not required.

4.4 Once this project has been completed will it require further funding to maintain its success as an initiative? Please provide details on how this initiative will be sustained or details of alternative sources of funding when funding through this Program ceases.

4.5 Please list the risks associated with the project and how they will be addressed.


Please refer to the application guidelines and the notes below when completing the table on the following page

How much can you apply for?A grant up to a maximum of $200,000 per project is available from the Criminal Property Confiscation Grants Program. Funding will only be provided as a matching grant, ie the amount applied for must be matched by a contribution from your organisation, other sources or a combination of both.

What is a contribution?A contribution is the total amount your organisation will contribute towards the project. This amount must be at least 50% of the value of the project. The contribution can consist of both cash and in-kind services; however, the in-kind service component must not exceed more than 50% of the total value of the contribution.

For example, if you were applying for the full amount of $200,000, the total amount of your contribution is also $200,000. Of this $200,000 you must be able to provide a cash component of not less than $100,000 (50%). The remaining 50% may comprise $100,000 worth of in-kind services.

What are in-kind services and how are they valued?These are your organisation’s non-monetary contributions which are to be costed for the purposes of this application. They include, but are not limited to items such as administrative services, volunteer support for project related activities, use of the organisation’s vehicle(s), co-ordination / management services, lease / rental costs, telephone and other establishment expenses.

In addition to providing details of each in-kind contribution, you are also required to provide explanatory notes on how these have been costed. For example, award wages can be used as a guide to calculate services provided whilst telephone costs can be a pro rata estimate of your organisation’s overall telephone expenses.

Funding from other sourcesPlease include approved funding and applications still under consideration in the table. Details are to be provided at Item 4.8.

Purchase of EquipmentFunding is not generally provided for the purchase of equipment. However, there is provision to purchase equipment items up to the value of $5,000 where it is demonstrated that these items are essential to the project.

Please discuss the proposed purchase of equipment items with a member of the grants team before you submit your application.

Please refer to page 6 (point 11e) of the Guidelines for any proposal to purchase capital items over the value of $5,000.


4.6 In the table below please provide proposed income and expenditure for the duration of the project. Where exact figures are not known, please provide your best estimate. *Note: In-kind contributions must be itemised as budget notes at 4.6.1

Item Income Proposedexpenditure

DoJ funding $

Inc GST Ex GST

Funding from other sources (insert details in Item 4.8)Monetary In-kind*

Applicant Contribution

Monetary In-kind* Total $Advertising

Audit fees

Equipment purchases1:

Evaluation of project

Gas and electricity

Hire/leasing costs, other than vehicles (please specify at 4.6.1)

Insurance2:

Maintenance and repairs

Motor vehicle expenses (please specify at 4.6.1)

Other Consumables

Other operating costs (please specify at 4.6.1)

Postage, printing and stationery

1 Two written quotes shall be obtained and attached to this application for purchases over $5000

2 Public liability, Personal accident Professional indemnity - please specify


Item Income Proposedexpenditure

DoJ funding $

Inc GST Ex GST

Funding from other sources (insert details in Item 4.8)Monetary In-kind*

Applicant Contribution

Monetary In-kind* Total $Project Management / Administration Fees

Rates and taxes

Rent

Salaries and wages

Salary on costs (ie Superannuation, Leave, FBT)

Sundries (please list separately)

Telephone

Travel

Establishment costs for this project (please specify)

Other expense items (please specify)

Income/Expenditure (less GST)Total income must equal total expenditure unless you are assured of receiving cash income in addition to CPCGP funds

▲ ▲ ▲Insert this amount in the green box on Page 1 of this application.


4.6.1 Budget Notes: Please provide details to clarify in-kind contributions and any other items in the above table which require specification.

4.7 Is the project dependent on other funding? Yes No

If yes, please provide details:

4.8 Sources of income, other funding and support for the project

Income type Organisation name Amount/value of contribution of support ($)

Is support dependent upon this grant (yes/no)

Other grants Yes No

Other government grants

Yes No

Commercial sector Sponsorship

Yes No

Contributions from other sources

Yes No

In-kind contributions

Yes No

Other income Yes No

Total income from other sources

$ 0

4.9 In cases where funding (or other support) from other agencies is dependent on successfully obtaining support funding from the Criminal Property Confiscation Act 2000 Grant, please describe the circumstances.

5 Section 5 - Employment Component

5.1 Where there is an employment component of this project, please outline salaries, wages and / or salary on costs.

5.2 Where there is an employment component, please provide details of who will provide the employment infrastructure for the project.


6 Section 6 - EvaluationHow will the project be evaluated/ monitored throughout the term of the grant to ensure its success? Please provide a dot point summary.

7 Section 7 - Project Management CapacityPlease provide details of your organisation’s experience in managing funded projects. You may wish to attach a copy of an evaluation / final report of a recent funded project.

8 Section 8 - RefereesPlease provide full details of independent referees who can comment on your organisation and this application. These referees cannot be members of your organisation or its Board.Referee 1

Name

Title

Organisation

Contact number

Referee 2

Name

Title

Organisation

Contact number


9 Section 9 - Declaration

9.1 Applicant

I have read and understand the Criminal Property Confiscation Grants Program Policy and Application Guidelines.

I declare that I am currently authorised to sign legal documents on behalf of the organisation.

I declare that all the information contained in this application form is true and correct. I give permission to the Department of Justice to contact any persons or organisations

in the assessment of this application. I understand that information may be provided to other agencies as appropriate.

Applicant’s name (printed)

Position

Signed

Date:

9.2 Witness

Witness name (printed)

Signed

Date:

10Application checklistPlease complete the following checklist before submitting your application.

Completed and signed Application Form (an original signature of the Chairperson / President / Chief Executive Officer is required).

All sections of the Application Form are completed.

ABN details have been provided.

Copy (or electronic link if available) of most recent Annual Report is attached (if applicable).

Copies of the two most recent Management Committee Meeting minutes and the last AGM minutes are attached (if your organisation does not have an Annual Report).

Copy of your organisation’s Certificate of Incorporation and Constitution are attached (if applicable).

Supporting documents (eg letters of support, evaluation reports) are attached.

Proposed start date of project is not earlier than 1 November 2020.


Please note: Your completed application and attachments must be received by the Department of

Justice by 12 noon on the closing date of Wednesday 1 April 2020. Late applications will not be considered.

Please do not staple or bind your application and accompanying attachments. Faxed applications will not be accepted. Applications may be lodged by mail, in

person or by electronic mail. Requests for an extension to the submission deadline are not allowed.

Applications lodged by mail should be addressed to:

Criminal Property Confiscation Grants ProgramDepartment of JusticeGPO Box F317PERTH WA 6841

Applications lodged in person:

David Malcolm Justice Centre28 Barrack StreetPERTH WA 6000

You will need to go through a security screening process before you are able to take the elevator to Level 23 and hand deliver your application to Reception.

Please note that as the Reception Desk on Level 23 looks after all the departments in the David Malcolm Justice Centre, please ensure that the envelope is addressed to the Grants Team, Criminal Property Confiscation Grants Program, Level 31, Department of Justice.

Applications lodged by email should be sent to: [email protected]

For emailed applications the declaration must be signed by the authorised signatory for your organisation and attached as a scanned PDF to the emailed application. If you are unable to scan and send the declaration as a PDF please mail the signed hard copy of the declaration page to the grants team at the address above within three working days of sending the emailed application.

Please allow sufficient time for both mail delivery and electronic lodgements as applications received after the closing time of 12 noon on Wednesday 1 April 2020 will be ineligible for consideration.


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