Energy Resources of Australia Ltd (ERA) supports applications for community partnership funding demonstrating a clear benefit for the local community, including the Alligator River region in the Northern Territory.

To apply for community partnership funding from ERA, please complete this form. Alternatively download the hard-copy form to complete.

Applications will be assessed against ERA Education and Training, Health and Community Wellbeing, Environment, Sport and Culture, priorities. For more information on these priorities, refer to step five of this application. Applications are also subject to availability of funds.

To aid in a prompt decision on your application for funding, ensure the application is completed in full and details are correct.

Individual / Organisation Name

Project Name

Project Summary

Amount requested

Address

City

ZIP / Postal Code

State / Province

Country

Contact Name

Email

Phone

Registered Charity

Is your organisation a registered charity, or not for profit organisation which has tax exemption status? If your organisation is registered for GST, ERA will gross-up the approved funding for GST liability upon the issue of a Recipient Created Tax invoice

Yes

No

Type of support sought

Cash

In Kind

Once-off Donation

For Cash Funding

Total estimated cost of project ($)

Your contribution to the project ($)

Contribution from other grants / sponsors ($)

Total funding requested from ERA ($)

For In Kind

Please Specify Details and Quantity

Funding proposals must fall into at least one of ERA’s key priorities:

EDUCATION AND TRAINING

Increase recognition of the benefits of lifelong learning within the community
Improve education standards

HEALTH AND COMMUNITY WELLBEING

Support programmes which will improve the health and wellbeing of all members of the community, particularly the Traditional Owners and ERA staff.

ENVIRONMENT

Work with communities to address environmental challenges which impact on the region.

SPORT AND CULTURE

Strengthen support for sport and cultural diversity within the region Donations to charitable, non-profit and community-focussed organisations and activities will be considered if they align with our priority categories.

Donations to charitable, non-profit and community-focussed organisations and activities will be considered if they align with our priority categories.

Please indicate which ERA priorities your application addresses and how. (Please see above for definitions)

Education & Training

Health and Community Wellbeing

Environment

Culture

Please outline how your application addresses each priority selected above.

What other fund raising activities are taking place to supplement your funding request from ERA?

Please indicate other sponsors/funding authorities you or your organisation have approached and whether their support is confirmed:

Organisation	Amount ($)	Confirmed / Unconfirmed

Specifically, what groups or individuals will benefit from ERA’s assistance and how?

Please provide an estimation of the number of persons involved (by age range):

Participants (Youth)	Participants (Adults)	Volunteers (Youth)	Volunteers (Adults)	Spectators (Youth)	Spectators (Adults)

Bank

Branch Name

BSB

Account Number

Account Name

By signing this declaration, I state that all information contained in this application is true and correct, and that I am duly authorised to make this application. I understand that The Committee will meet on the dates advertised and I will be advised of the outcome in writing within 2 weeks of this meeting I accept that ERA reserves the right to accept or decline any requests

Signature

Name

Position

Community Partnerships Form