Grass Roots Fund Application

HNSW is committed to protecting the personal information we collect from you.

Please note that any personal information collected by HNSW will only be used or disclosed for the purpose of processing your refund.

Please also note that any personal information that is collected or disclosed will be done so in accordance with HNSW’s Privacy Policy, a copy of which can be accessed by clicking here.

Organisation Name*

Legal Entity Type*

ABN/ACN/Incorporation No.*

Organisation Address*

Key Contact Name*

Key Contact Role*

Key Contact Email*

Key Contact Phone*

Organisation Bank Account Name*

Organisation BSB (Please enter BSB in this format 000-000)*

Organisation Account Number (0-9 numerical digits)*

Does your Organisation have registered members / participants?*

Can your organisation demonstrate it has been financially impacted by COVID-19 between March 2020 and June 2020?*

Are you able to confirm that should your organisation receive the maximum amount of funding (up to $1,000) it will be acquitted on fixed costs such as insurances, power, telephone and internet, fixed vehicle or equipment costs (lease, registration), and other base operating costs including affiliation fees, EFTPOS and banking fees, IT support arrangements and essential equipment.*

I certify that the information given in this registration is true and correct, and acknowledge that false or misleading information could impact on the organisations eligibility to receive funding. I acknowledge that information in my application may be shared with the Office of Sport for the purposes of review and auditing.*