The Australia-Indonesia Institute
Grant Application Form
NB Before preparing this application please read carefully the Guidelines and Conditions applying to Grant Applications and Approvals
Name of Applicant(s):
Address:
Tel. (Home)
(Work)
Fax. (Home)
(Work)
E-mail:
Project Title:
Amount Applied for $
Duration of the project:
From \ \ To \ \
Description of the project:
Main aims and objectives of the project:
How do you propose to achieve these objectives ?
What criteria will you use to judge the success of the project ?
Please state here the envisaged benefits to Australia from the project.
What publicity strategy will you pursue to promote the project activities and to disseminate the results?
How will AII support be recognised?
Why do you consider the Australia-Indonesia Institute an appropriate sponsor for this project.?
Please list here any other Australian individuals or organisations that will participate or have been approached to participate in this in project and summarise how you expect them to contribute.
(Please provide documentary evidence where involvement of other organisations\ individuals has been agreed to.)
Indonesian Interest:
What counterpart organisation in Indonesia, will be participating or has been approached to participate in this project.?
Please indicate how the Indonesian interest will contribute towards the successful completion of this project.
How many persons will participate directly in the project
( ie administrators , performers etc.) Please estimate.
In Australia:
Males
Females
In Indonesia:
Males
Females
How many persons will participate indirectly in the project( ie as spectators , readers , viewers etc.). Please estimate:
In Australia:
In Indonesia:
Budget:
Funds available from your own sources $
Funds sought from other Australian sources $
Matching funds from Indonesian counterpart organisation $
Funds sought from the Australia-Indonesia Institute $
Please provide here an itemised expenditure statement indicating which items you expect the Australia-Indonesia Institute to fund.
Please state here the sources and amounts of funds expected or
available from other Australian sources.
Please give evidence of your qualifications for carrying out the proposed project.
Have you , your organisation or other principle in this project previously received funding from the Australia-Indonesia Institute?
Yes/No ( If "Yes", please provide details )
Please give the names & addresses of the two referees you have nominated to comment on the value of your project, its objectives and the strategies to achieve them.
Name:
Address:
Name:
Address:
Note: It is the applicant's responsibility to nominate referees and to ensure that their comments on the project reach the Institute in time for assessment.
The grant application will not be considered for funding by the Institute without the nominated referees' written comments.
I \We certify that the information given in this application is true to the best of my\our knowledge.
Signature of applicant(s) Date
____________________________ \ \
____________________________ \ \