Regional Arts Development Fund INDIVIDUAL PROFESSIONAL DEVELOPMENT GRANT APPLICATION FORM Title Mr Mrs Ms Other (please specify): Name Do you live in the CHRC region? Yes No APPLICANT Age group under 18 18 25 25 55 55 + – – DETAILS Have you previously been successful for a RADF Grant? Yes No If yes, has that grant been successfully acquitted? Yes No Street Address Suburb State Postcode Postal Address CONTACT Suburb State Postcode DETAILS Mobile Home Email Website (if applicable) Activity Title Activity Brief: (describe the activity in 100 words or less) ACTIVITY SUMMARY RADF Grant Requested $ Total Activity Cost $ Start Date / / End Date / / Outcome Report Due Date / / (8 weeks from end date) ARTFORM Community Arts and Cultural Development Writing Dance OF ACTIVITY Visual Arts, Craft and Design Theatre Heritage Multi-arts What is the artform of your activity? Select ONE only Central Highlands Regional Shire Council, PO Box 21, 65 Egerton Street, Emerald QLD 4720 Ph 1300 242 686 Fax 1300 242 687 Email: Website: • ●
Regional Arts Development Fund INDIVIDUAL PROFESSIONAL DEVELOPMENT GRANT APPLICATION FORM APPLICANT DETAILS Title Mr Mrs Ms Other (please specify): Name Do you live in the CHRC region? Yes No Age group under 18 18 – 25 25 – 55 55 + Have you previously been successful for a RADF Grant? Yes No If yes, has that grant been successfully acquitted? Yes No CONTACT DETAILS Street Address Suburb State Postcode Postal Address Suburb State Postcode Mobile Home Email Website (if applicable) ACTIVITY SUMMARY Activity Title Activity Brief: (describe the activity in 100 words or less) RADF Grant Requested $ Total Activity Cost $ Start Date / / End Date / / Outcome Report Due Date (8 weeks from end date) / / ARTFORM OF ACTIVITY What is the artform of your activity? Select ONE only Community Arts and Cultural Development Writing Dance Visual Arts, Craft and Design Theatre Heritage Multi-arts Central Highlands Regional Shire Council, PO Box 21, 65 Egerton Street, Emerald QLD 4720 Ph 1300 242 686 • Fax 1300 242 687 Email: ● Website:
CHRC-RADF-Individual-application-form-2018-19.docx