ADG Community Grants Program Application Form

ADG Community Grants Program - Round 4

Application Form 2025

Organisation Information

1. Organisation Contact Person

Name of contact person *

Role *

Phone

Mobile *

Email *

2. Organisation Details

Name of organisation *

ABN *

Address *

Phone *

Email *

Website

Is your organisation registered for GST? *

YesNo

How long has your organisation been in operation? *

Attach a copy of your ASIC Company Summary *

Browse

Note: To obtain this document:

Go to - Search Company and Other Registers
In the top right, Search ASIC Registers search
Within: Select organisation and business names
For: Your Company name
Select Go
Select your entity from the Organisations and Business Names list

Your association Summary will appear – go to View Summary PDF and attach

Other (Please Specify) *

Number of members/employees? *

Briefly describe your organisation’s main activities ** 300 characters

Which geographical locations does your organisation benefit? *

Alice SpringsDarwinTennant CreekOther

Please Specify *

Which ADG strategic pillar does your project align with? *

Indigenous AdvancementTourism EnhancementStakeholder and Community Support

3. Project Details

Project Title *

Project summary including purpose suitable for public release **300 characters

Total ADG Funding Sought *

Other (Please Specify) *

Outline the benefit of this project to your community **300 characters

To what extent does the project support diversity and inclusion? **300 characters

Does your project provide support or engage opportunities with First Nations people? Provide details. **300 characters

How much of the grant funding will be paid to an NT owned and operated company? *

100%>50%>25%0%

How many people will be directly impacted by this project? *

How many people will be indirectly impacted by this project? *

Over what time frame do you anticipate your project will continue to deliver benefits or have a lasting impact? *

12 months+6 months+3 months+One-off event

Please provide details *

What are your measures of success? **300 characters

Where will your measures of success be reported? *

Are any members or attendees employed by ADG? *

YesNo

Provide details *

Has your organisation previously been a recipient of an ADG Community Grant? *

NoYes, 6 months agoYes, 12 months agoYes, 18 months ago

How will this project or event be promoted? *

Recognition of the grant in the internal newsletter/Annual reportPublic recognition on own social media platformsOther (please specify)N/A (please specify)

Other (Please specify) *

N/A (Please specify) *

Specify placement of ADG logo *

*Where appropriate, ADG will liaise with the organisation to attend/participate/recognise this project.

Funding Details

4. Please outline the cost breakdown of your activities

*ADG may request quotes or other documentation to support your cost breakdown.

Item desciption *

Item cost ($) *

Amount requested ($) *

5. Please detail any contributions from other donors/sources (financial and in-kind) to support your activities

Company/Organisation

Confirmed Support ($ or in-kind details)

Timeline

Start Date *

End Date *

6. Other Key Milestones (if known)

Milestone

Submission Checklist

I have checked that my organisation is eligible for assistance. *

I have completed the application form and attached any other relevant additional information. *

I have attached the ASIC Company Summary *

Applicant Name *

Role in Organisation *

Applicant Signature *

Draw signature|Type signatureClear

Date *

CAPTCHA *

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