ADG Community Grants Program Application Form

ADG Community Grants Program - Round 5

Thank you for your interest in the ADG Community Grants Program.ADG is committed to supporting projects that strengthen communities, promote inclusion, and deliver meaningful impact across the Northern Territory. This application form will help us understand your organisation and project so we can assess eligibility and alignment with our strategic priorities.Please read the guidelines carefully before completing this form. For more information about the program, visit: https://www.adgnt.com.au/community-grants

Privacy Statement

ADG is committed to protecting your privacy. Information provided in this application will be used for the purpose of assessing your eligibility and administering the Community Grants Program. ADG may also use your information for reporting and promotional purposes in accordance with its Privacy Policy.For more details, please refer to ADG’s Privacy Policy: https://www.adgnt.com.au/privacy.

Organisation Information

1. Organisation Details

Name of organisation **Legal name of the organisation, school, or group applying

Organisation Type *

Other (Please Specify) *

Address *

Phone *

Email *

Website

How long has your organisation been in operation? *

ABN

I confirm the ABN provided is active and belongs to the organisation named above. *

COMMUNITY OR SPORTING GROUP (NOT INCORPORATED)

Some community and sporting groups are informal and are not registered as a legal entity.

Does your group currently have a sponsoring organisation that would administer grant funds if your application is successful? *

YesNo/ Not yet confirmed

Sponsoring Organisation Name *

Sponsoring organisation ABN (if applicable)

I confirm the sponsoring organisation is aware of this application and agrees to administer grant funds on behalf of our group if the application is successful. *

If your group is not incorporated, ADG may require grant funds to be administered through an appropriate organisation. This will be discussed with successful applicants.

I acknowledge this and agree to work with ADG to confirm suitable arrangements if the application is successful.
*

SCHOOL

School Name *

Education Authority *

Other (Please Specify) *

I confirm this application has the approval of the school Principal or authorised delegate. *

REGISTERED CHARITY

Is the organisation registered with the Australian Charities and Not for profits Commission (ACNC)? *

YesNoUnsure

To confirm registration:

Visit https://www.acnc.gov.au/charity
Search by organisation name or ABN
Confirm status is “Registered” from the search result

ACNC Registration Number (optional)

I confirm our ACNC registration above is current. *

INCORPORATED ASSOCIATION

Incorporation Number

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

Please upload ONE of the following documents in the Document Upload field below:

ASIC Company Summary (companies)
ABN Lookup Summary (organisations with an ABN)
ACNC Charity Listing (Registered charities) Certificate of Incorporation incorporated association)
Other relevant verification document

Please upload a PDF of an endorsement email confirming support for this grant application in the Document Upload field below.

The email must:

be from the school Principal or an authorised delegate (Deputy Principal or Business Manager)
clearly state support for the application
be sent from an official school email address

Document Upload *

Browse

ADG recognises that not all legitimate organisations, schools, or community groups hold an ABN. This form uses proportionate verification based on organisation type. If you are unsure what applies to you, please contact the ADG Community Grants team at communitygrants@adgnt.com.au

2. Organisation Contact Person

Name of contact person *

Role *

Phone

Mobile *

Email *

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 and Acknowledgements

Please note

As part of the ADG Community Grants Program, recipients are asked to complete this Project Status Update Form once their project or event has been completed. To help ADG share and celebrate funded projects, applicants are kindly requested to provide at least two (2) high‑resolution photographs (minimum 1MB each) related to the activity or event. Where possible, images should show the project, goods, or activities in use with participants or beneficiaries.

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

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

I acknowledge that I have read and understood ADG’s Privacy Policy and consent to the use of my information as outlined.

ADG values sharing the impact of funded projects through media, storytelling and reporting.

I acknowledge and agree to support ADG’s media and reporting activities and agree that:

ADG may publish recognition of the funded project on its official channels, including LinkedIn and other social media platforms.
ADG may create a media release about the project and may request high‑resolution photographs, including those provided as part of post‑project reporting, or arrange a visit to capture images where appropriate.
I agree to provide reasonable support for these activities, including supplying high‑resolution images or facilitating access for photography, subject to prior agreement and cultural considerations.

*

I confirm the information provided in this application is true and correct. *

I confirm that if this application is successful, grant funds will be paid into a bank account held by the organisation, school, or approved sponsoring organisation named in this application. *

If you have any questions about this application, reporting requirements, or media and photo requests, please contact the ADG Community Grants team at communitygrants@adgnt.com.au

Applicant Name *

Role in Organisation *

Applicant Signature *

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Date *

CAPTCHA *

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