EmailMeForm
Netball WA Community Facilities Fund (CFF)
Small Grants Application
APPLICANT DETAILS
Select what kind of entity you are
*
Please select
Club
Association
Affiliated Club
Region Name
*
Please select
Metro North Region
Metro Central Region
Metro South Region
Peel Region
Great Southern Region
Midwest Gascoyne Region
North West Region
South West Region
Wheatbelt / Goldfields Region
Association Name
*
Please select
Joondalup
Lancelin Ledge Point
Noranda
South Midlands
Wanneroo Districts
West Coast Men's & Mixed
Belmont
Eastern Hills
Kalamunda & Districts
Perth
Swan Districts
Fremantle
Rockingham & Districts
Southern Districts
Success
Boddington
Mandurah
Peel Football Netball League
Pinjarra
Serpentine/Jarrahdale
Waroona & Districts
Albany
Denmark
Esperance
Katanning
Kojonup
Narrogin & Districts
Ongerup
Ravensthorpe
Carnarvon
Exmouth
Gerladton
Kalbarri
North Midlands
Northampton
Turquoise Coast
Broome
Derby
Karratha
Kununurra
Newman
Paraburdoo
Port Headland
Tom Price
Wickham
Bridgetown
Bunbury
Busselton
Collie
Donnybrook
Eaton
Harvey
Leschenault
Manjimup
Margaret River
South West Netball Football League
Avon
Central Midlands
Central Midlands Coastal
Central Wheatbelt
Corrigin & Districts
Cunderdin Nippers
Dalwallinu
Eastern Goldfields
Kellerberrin Ladies
Merredin
Mortlock
Northam
Quairading
Wongan Hills
Yilgarn
York Junior
York Senior
Please type the name of your club below
*
Facility Address
*
Enter Postal Address if different from Facility Address
Details of Preferred Contact Person
*
First
Last
Enter the first and last name of your preferred contact person
Position
*
Contact Number
*
Email
*
Does the Applicant have an ABN?
*
Yes
No
If yes, please provide the ABN
Is the Applicant registered for GST?
*
Yes
No
Is the Applicant Incorporated
*
Yes
No
If yes, please provide the Applicants Incorporation number
PROJECT DETAILS
Describe the project the funds will go towards if you are successful
*
Upload your project funding template
Do you share your facility with other sports/clubs?
*
Yes
No
If yes, enter the names of the other sports/clubs below
Please enter the Applicants Membership numbers for the below years
*
Membership number
2016
2017
2018
2019
Has the applicant participated in the Netball Community Raffle
*
Yes
No
Enter the number of raffle books sold by the Association, Club or Affiliated Clubs each year they have participated in the Netball Community Raffle
2016
2017
2018
2019
APPLICANT'S CERTIFICATION
*
I certify that the information supplied is to the best of my knowledge, true and correct.
Name of person submitting application form
*
First
Last
Position of person submitting application form
*