1. APPLICANT DETAILS 1.1 Applicant Type Are you applying as an individual a group/unincorporated body an organisation (please tick ONLY ONE): Go to 1.2 Go to 1.3 Go to 1.4 1.2 Individual Mrs Mr Ms If you are under 18 years of age Other (please specify): : please give your date of birth: Given names: Family name: Do you have Australian citizenship or permanent residency Y N status? Are you: Male Female Go to 1.5 1.3 Groups Name of group: Collectives or cooperatives are community groups or groups of Name of auspicing organisation/individual artists that are not incorporated Note: this organisation or individual must complete but must be auspiced by an Section 1.8 incorporated organisation including Local Government, or Details of accountable person in an individual with an ABN. One person must be nominated Mrs Mr Ms Other (please specify): as the accountable : representative of the collective Given names: for management, reporting and financial matters. Go to 1.5 Family name: 1.4 Organisation Eligible organisations include name of organisation: arts and cultural not-for-profit organisations and Australian companies that are either Details of contact person in organisation based in or able to demonstrate how their project Mr Title: Mrs Ms Other (please specify): will directly benefit arts and culture. names: Organisations must be Family name: registered under law as either incorporated associations or a Role of contact company limited by guarantee. person: What is your organisation’s legal status? Go to 1.5 (eg limited by guarantee; incorporated; etc) 1.5 Applicant Contact Details Street address: Suburb/town: State: Postcode: Postal address: Suburb/town: State: Postcode: Work: ( ) ( ) ( ) Telephone: Home: Fax: Email: Website address
1. APPLICANT DETAILS 1.1 Applicant Type Are you applying as (please tick ONLY ONE): an individual a group/unincorporated body an organisation Go to 1.2 Go to 1.3 Go to 1.4 1.2 Individual If you are under 18 years of age please give your date of birth: Mr Mrs Ms Other (please specify): Given names: Family name: Do you have Australian citizenship or permanent residency status? Y N Are you: Male Female Go to 1.5 1.3 Groups Collectives or cooperatives are community groups or groups of artists that are not incorporated but must be auspiced by an incorporated organisation including Local Government, or an individual with an ABN. One person must be nominated as the accountable representative of the collective for management, reporting and financial matters. Name of group: Name of auspicing organisation/individual Note: this organisation or individual must complete Section 1.8 Details of accountable person in Mr Mrs Ms Other (please specify): Given names: Family name: Go to 1.5 1.4 Organisation Eligible organisations include arts and cultural not-for-profit organisations and Australian companies that are either based in or able to demonstrate how their project will directly benefit arts and culture. Organisations must be registered under law as either incorporated associations or a company limited by guarantee. name of organisation: Details of contact person in organisation Title: Mr Mrs Ms Other (please specify): names: Family name: Role of contact person: What is your organisation’s legal status? (eg limited by guarantee; incorporated; etc) Go to 1.5 1.5 Applicant Contact Details Street address: Suburb/town: State: Postcode: Postal address: Suburb/town: State: Postcode: Telephone: Work: ( ) Home: ( ) Fax: ( ) : Email: Website address :