Section 4 Project budget – Please provide details of the income and expenditure for the project, excluding GST. Note that the total income must equal total expenditure. Please ensure that the details clearly show how the required 2:1 funding ratio is being met. Applicants are required to submit the project budget using the categories provided. If additional space is required please provide a summary here and the details on a separate sheet (or sheets) using the same categories. Ensure that all budget contributions are confirmed in writing, by a letter or email. Include copies of those letters/emails in the application pack. Income Amount Expenditure Amount Grant amount requested from $ Project construction $ this program state government funding $ Contingencies and escalations $ Local government funding $ In-kind labour $ Federal government funding $ In-kind support $ – Registered Commercial Builder Funds from the men’s shed group $ $ Management from other community $ Other (please specify below) $ organisations Funds from business contributions $ $ Funds from philanthropic contributions $ $ In-kind support from the men’s shed $ $ group participants In-kind support from other sources $ $ (please specify) $ $ income $ Total expenditure $ Declaration I that the information in this application and attachments is to the best of my knowledge true and correct. I will notify the Department of Health and Human Services (the department) of any changes to this information and any circumstances that may affect this application. I acknowledge that the department may refer this application to external experts or other government departments for assessment, reporting, advice, comment or for discussions regarding alternative or collaborative grant funding opportunities. I understand that the department is subject to the Freedom of Information Act 1982 and that if a freedom of information request is made, the department will consult with the applicant before any decision is made to release the application or supporting documentation. I understand that this is an application only and may not necessarily result in funding approval. To be signed by a person with delegated authority to apply such as chairperson, secretary, or treasurer – of the men’s shed group, or if an auspice is being used, from the auspice organisation. Signature: Print name: Date: Position:
Section 4 – Project budget Please provide details of the income and expenditure for the project, excluding GST. Note that the total income must equal total expenditure. Please ensure that the details clearly show how the required 2:1 funding ratio is being met. Applicants are required to submit the project budget using the categories provided. If additional space is required please provide a summary here and the details on a separate sheet (or sheets) using the same categories. Ensure that all budget contributions are confirmed in writing, by a letter or email. Include copies of those letters/emails in the application pack. Income Amount Expenditure Amount Grant amount requested from this program $ Project construction $ state government funding $ Contingencies and escalations $ Local government funding $ In-kind labour $ Federal government funding $ In-kind – support $ Funds from the men’s shed group $ Registered Commercial Builder Management $ from other community organisations $ Other (please specify below) $ Funds from business contributions $ $ Funds from philanthropic contributions $ $ In-kind support from the men’s shed group participants $ $ In-kind support from other sources $ $ (please specify) $ $ income $ Total expenditure $ Declaration I that the information in this application and attachments is to the best of my knowledge true and correct. I will notify the Department of Health and Human Services (the department) of any changes to this information and any circumstances that may affect this application. I acknowledge that the department may refer this application to external experts or other government departments for assessment, reporting, advice, comment or for discussions regarding alternative or collaborative grant funding opportunities. I understand that the department is subject to the Freedom of Information Act 1982 and that if a freedom of information request is made, the department will consult with the applicant before any decision is made to release the application or supporting documentation. I understand that this is an application only and may not necessarily result in funding approval. To be signed by a person with delegated authority to apply – such as chairperson, secretary, or treasurer of the men’s shed group, or if an auspice is being used, from the auspice organisation. Signature: Print name: Date: Position: