Full legal name Trading name Legal entity status (for example, incorporation, company) Registration for GST Yes / No Australian Business Number (ABN or ACN) Postal address Contact person Telephone number Mobile number Email address Is your organisation a legal entity with which the department is able to enter Yes / No into a Service Agreement? Does your organisation agree to enter into a Service Agreement with the Yes / No Department of Health and Human Services? A copy of the standard Service Agreement terms and conditions can be obtained on the Funded Agency Channel in the Department of Health and Human Services Information section at: Does your organisation have the capacity to accept electronic funds transfer Yes / No as a facility for payments? Does your organisation agree to meet monitoring and reporting Yes / No requirements? For more information, see: Evidence of the financial viability of the organisation (except local government and government schools) Auspice Arrangement Is this an auspice application? Yes / No If yes, please complete the following details Name of community group application is on behalf of Community group contact person Contact number Contact Is the Memorandum of Understanding between the auspice organisation Yes/No and community group attached to the application Location details of the neighbourhood house Main street address Town/suburb
Full legal name Trading name Legal entity status (for example, incorporation, company) Registration for GST Yes / No Australian Business Number (ABN or ACN) Postal address Contact person Telephone number Mobile number Email address Is your organisation a legal entity with which the department is able to enter into a Service Agreement? Yes / No Does your organisation agree to enter into a Service Agreement with the Department of Health and Human Services? A copy of the standard Service Agreement terms and conditions can be obtained on the Funded Agency Channel in the Department of Health and Human Services Information section at: Yes / No Does your organisation have the capacity to accept electronic funds transfer as a facility for payments? Yes / No Does your organisation agree to meet monitoring and reporting requirements? For more information, see: Yes / No Evidence of the financial viability of the organisation (except local government and government schools) Auspice Arrangement Is this an auspice application? Yes / No If yes, please complete the following details Name of community group application is on behalf of Community group contact person Contact number Contact Is the Memorandum of Understanding between the auspice organisation and community group attached to the application Yes/No Location details of the neighbourhood house Main street address Town/suburb
2018%20Neighbourhood%20House%20Coordination%20Program%20-%20New%20neighbourhood%20houses%20funding%20guidelines%20and%20application%20form.DOCX