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 boriginal and Torres Strait Islander
Arts Development
Project Assistance and Individual Development
* Before completing this form, ensure you have discussed your application with the relevant Arts South Australia officer (ph: 8463 5444).
1 Applicant’s details ! Important
Please refer to the Arts South Australia website www.arts.sa.gov.au for assistance in completing this form.
Please submit one signed original hard copy of your entire application, inclusive of all support material AND one digital version of your entire application on USB, again, inclusive of all support material. The total combined size of your digital version must not exceed 6MB of data. Submit applications to:
Arts South Australia
Level 16, Wakefield House
30 Wakefield Street
ADELAIDE SA 5000
or
Arts South Australia
GPO Box 2308
ADELAIDE SA 5001
Arts South Australia will not accept late applications or applications postmarked after 5pm on the closing date.
Name of applicant (individual / group / organisation):
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Street address:
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Postcode:
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Postal address:
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Postcode:
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Work ph:
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Home ph:
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Fax:
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Mobile:
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Email:
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Website:
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Is this application by:
Individual Group Inc. association
Company State Gov. agency Local Gov. agency
Do you have an ABN? Y N If you do, record here:
Do you have an ACN? Y N If you do, record here:
Have you applied for an ABN and are waiting for it to be allocated? Y N
Are you registered with the Australian Tax Office for the GST? Y N
2 Organisations and groups only
Contact person:
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Position:
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Chair / CEO / Responsible person:
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Position:
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Postal address:
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Postcode:
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Work ph:
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Email:
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3 Individuals only
Gender: M F Other
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* Do you have an Australian Citizenship or permanent residency status? Y N
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* Are you currently living in SA? Y N
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Important: If you have answered NO to either of these questions *, please address in your application.
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4 Project summary
Title:
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Brief description:
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Start date:
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End date:
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5 Amount requested from Arts South Australia
6 Art form area
7 Arts practice
Poetry Fiction Non-fiction
Visual art Craft Design
Dance Theatre Music
Digital art Community arts Multi art form
Interdisciplinary arts Other
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8 Professional status
What is your professional status, or that of your group?
Emerging Established Not applicable
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9 Other information (individuals only)
Are you an Aboriginal or Torres Strait Islander artist? Y N
If yes, what is your language group?
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Are you a person with disability? Y N
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Are you a person from a culturally and linguistically diverse background? Y N
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Are you a person living in a regional or remote community? Y N
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10 Other information (about the project)
Does this application involve specific initiatives, targeted services or programs with the following groups or individuals?
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Youth (under 26) Y N
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People with disability Y N
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People from culturally and linguistically diverse backgrounds Y N
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People living in regional or remote communities Y N
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Does the activity (at any stage) involve working with children and
young people aged under 18 years? Y N
If yes, have you read, and do you comply with Arts South Australia's
Protocols for working with children in art? Y N
Protocols can be downloaded from: http://arts.sa.gov.au/protocols-for-working-with-children-in-art/
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* Does this project directly involve Aboriginal and Torres Strait Islander people as artists or participants? Y N
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* Does this project involve the representation of Aboriginal and Torres Strait Islander people, art or culture? Y N
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Important: if you have answered YES to either of these questions *, you must provide additional information on the Aboriginal and Torres Strait Islander arts processes and protocols being followed in your proposal. Applications from or involving Aboriginal and Torres Strait Islander artists or cultures should be discussed with the Arts Development Officer, Aboriginal and Torres Strait Islander Arts, prior to the application being submitted.
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How did you find out about Arts South Australia’s support and funding programs?
Website Social media (ie. Facebook) Arts South Australia information session
Word of mouth Print advert / newsletter Arts South Australia email bulletin
Other
11 Auspicing (if applicable)
If you would like assistance with the financial management of your project, please contact an Arts South Australia project officer prior to submitting your application.
Will this project be auspiced by a third party? Y N
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12 Support material
Please list every item of support material that you have included with your application.
Type of support material (ie. books, DVD, CDs) Number of copies / samples
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1.
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2.
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3.
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4.
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5.
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6.
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13 Referees
Please provide name, organisation and contact phone number of three referees.
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1.
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2.
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3.
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14 Funding proposal
A Project outline
Description of project (eg. what, where, how, who, why and when).
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B Project participants, skills and background
Please list all artists involved in the project and include a brief description of their role and skills.
Additional CVs or short biographical information should be attached.
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C Project participant confirmation
Everyone involved in the project needs to provide signed / written confirmation.
Name Confirmed Signed Date
Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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Y N
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D Budget
All applicants must complete an income and expenditure budget and include details of all other funding sources for the project. You may use your own budget page or the one provided. It is important that this budget balances – the total income + total expenditure must be equal.
Income $
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Expenditure $
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(include both cash & in kind expenditure)
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Application contribution
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Artists’ Fees
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Cash
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In kind support
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Other grants or funding (ref Q7)
Approved
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Pending approval
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Sub-total (cash / in kind)
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Amount requested from Arts South Australia
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TOTAL INCOME:
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TOTAL EXPENDITURE:
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15 Authorisation
Tick each relevant box and sign at the bottom (note: unsigned applications are considered ineligible).
I, certify that:
I have read the Arts South Australia program guidelines and have discussed my application with the relevant Arts South Australia officer
I am an eligible applicant
I have no overdue funding acquittals due to any Arts South Australia program (speak to an Arts South Australia officer if you are not sure)
The activity I am applying for is due to start after the relevant notification date
The information in my application is, to the best of my knowledge, complete and accurate
I understand that anything wrong or missing may disqualify my application
I understand that the peer assessment panel may decide not to recommend my application
I consent to Arts South Australia using the personal information I have provided for the purpose of managing the grant assessment and approval process, including the collation of statistics
I agree to my name, suburb, grant details and project description being presented in media releases and published on the Arts South Australia website, if my application is successful
I consent to Arts South Australia using the personal information I have provided to advise me of Arts South Australia grant programs, services, initiatives and events
I consent to Arts South Australia providing my name, project description and contact details to Members of Parliament to enable letters of congratulation to be sent, if my application is successful, and acknowledge that Arts South Australia is then unable to prevent the information being used for other purposes
My project involves working with children and young people aged under 18 years and that I have read and agree to comply with Arts South Australia’s Protocols for Working with Children in Art: http://arts.sa.gov.au/protocols-for-working-with-children-in-art/
If my application is successful, I agree to comply with Arts South Australia’s requirement to adopt and implement a Respectful Behaviours policy and procedure. (For more information, and guidance and resources, visit http://arts.sa.gov.au/respectful-behaviours)
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Name:
Signature: Date:
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Office use only Client number: Application number:
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