External Funding Assessment PM-FM-17

This document has been developed to manage external requests for funding that are $25,000 or less. The Delegations of Authority document outlines more detailed requirements regarding approvals and tender processes. The LHA Executive Officer has the delegation to approve new projects of $25,000 or under without reference to the Board. The LHA EO can also approve all expenditure above $25,000 provided it has gone through an approved Board process, eg. an individual Project application or LHA Annual Budget approval.

1. Types of funding requests

The types of external funding requests that LHA receives in the $0-25,000 range vary, but they typically fall into one of the following categories:

Sponsorship opportunities
Full or partial financial support to enable small projects/initiation
Scoping projects designed to initiate diamond projects

Current budget allocations for this type of work are as follows:

Item	22/23 FY	23/24 FY	24/25 FY
Sponsorships	$50,000	$52,000	$54,000
Small grants	$100,000	$104,000	$108,160
Project scoping	$150,000	$156,000	$162,240

2. Process

Requests for funding must be made to the Assembly in writing, using the relevant project proposal template.

Receipt of the application will be acknowledged by the info@healthassembly.org.au email address
Requests will be forwarded to the LHA Executive Officer and the LHA Team Leads
Approval of a funding request requires approval from the LHA EO based on the support of the relevant LHA Team Lead, Board Chair or a Community Board member.

Requests will be assessed using simple and consistent criteria.

	Y	N	N/A
Does the request align with the Assembly's values and principles?
Has this request been submitted to the Assembly previously?
Does the request meet at least one of the Assembly's strategic objectives?
Does the request present unreasonable risk to the Assembly?
Is the Assembly suitably resourced to support the request at this time?
Does the applicant/organisation demonstrate capability to complete the project?
Has the applicant/organisation received previous grants with successful completion?

On a scale of 1 to 10 how Innovative is this idea?	1/10
Improve health and wellbeing in Latrobe Valley Increase awareness of the Assembly Provide opportunities to learn or work differently Generate data/insights to inform future projects Foster opportunities to strengthen collaboration/partnerships
Other comments {field:share_your_idea_1713318121844}

Requests will be assessed as they arrive, with an outcome communicated to applicants within 10 business days of receipt. Outcomes must be communicated to applicants in writing.

The Executive Officer, the relevant Team Lead, Board Chair or the nominated Community Board member may hold meetings to discuss assessment of the request. A decision will be made via email wherever possible to minimise turnaround times and to formally document the outcome.

Successful Funding Applications will be communicated to the LHA Board by the EO on a quarterly basis (Matters for Noting).

3. Outcome

To be completed.

Application received on:	{other:date} ({other:time})
Application title:	{field:proposed_project_title_1713317879524}
Amount $ requested:	{field:total_amount_requested_from_lha_1713330337846}
Amount $ pledged:	{field:total_amount_requested_from_lha_1713330337846}
Assessed by:
Outcome:
Responded to Applicant:

Signature sign off.

Name:

Title:

Date:

File in: Share point / Finance / External Funding-Sponsorship / relevant year

Latrobe Health Assembly
Community Grants Program

Application Form

Eligibility and Compliance check (All fields mandatory)

I have read the Latrobe Health Assembly Health Innovation Grants Program Guidelines and agree to the terms and conditions set out in this document. Response: {field:i_confirm_that_i_have_read_the_latrobe_health_assembly_community_grants_guidelines_please_tick_box_to_accept_1713055842108}

My {field:this_application_is_on_behalf_of_an_1713056125589} is based within Latrobe Valley or provides services or benefits primarily to the Latrobe Valley Community. Response: {field:this_application_will_provide_services_or_benefits_primarily_to_people_within_the_latrobe_valley_community_1713063191633}

My proposed idea will take place in Latrobe Valley. Response: {field:this_application_will_provide_services_or_benefits_primarily_to_people_within_the_latrobe_valley_community_1713063191633}

Please confirm the applicant/organisation:

Has a bank account for Electronic Funds Transfer (EFT) of grant funds. Response: {field:the_host_organisation_association_business_holds_a_bank_account_for_electronic_funds_transfer_eft_of_grant_funds_1713062402389}

Is not subject to any current or impending legal action which could impact on the financial viability of the organisation? Response: {field:the_host_organisation_association_business_is_not_subject_to_any_current_or_impending_legal_action_which_could_impact_on_the_financial_viability_of_the_organisation_1713062377978}

Holds appropriate public liability insurance of, at minimum, $10 million (Upload copy of current certificate). Response: {field:the_host_organisation_association_business_holds_appropriate_public_liability_insurance_of_at_minimum_usd10_million_1713062803033}

Date of Application: {other:date} ({other:time})

Contact Details

Individual / Organisation / Community Group / School name: {field:individual_organisation_community_group_school_name_1713301717618}
ABN: {field:abn_1713301758831}
Postal address: {field:postal_address_1713301804775}, {field:town_suburb_1713301825311}, {field:state_1713301846647}, {field:postcode_1713301993049}

Primary Contact

First name: {field:your_first_name_1713063088896}
Last name: {field:your_last_name_1713063077698}
Position: {field:position_1713165623076}
Email address: {field:email_address_1713165647165}
Phone: {field:phone_number_1713165666418}

Auspice Details/Contacts

Are you working in partnership with an auspice agency? Response: {field:are_you_working_in_partnership_with_an_auspice_agency_1713302486540}

If yes please provide the contact details of your auspice agency's main contact and upload a copy of the letter confirming auspice arrangement.

First name: {field:first_name_1713302539504}
Last name: {field:last_name_1713302557092}
Organisation: {field:organisation_1713302582425}

If you are proposing to work with Latrobe Health Assembly to auspice your event; please attach the written approval with your application and email info@healthassembly.org.au or call (03) 5173 8400.
Response: {field:auspice_organisation_letter_of_support_doc_docx_pdf_1713303150809:filename}

If relevant, please include the contact details of the Latrobe Health Assembly employee who you have been speaking with.

LHA contact name: {field:lha_contact_name_1713316241824}
LHA Contact Number and/or email address: {field:lha_contact_number_and_or_email_address_1713316259389}

Summary of proposed activity

Title: {field:proposed_project_title_1713317879524}

Latrobe Health Assembly Priority Area's this project aligns with: {field:theme_that_the_project_will_address_1713317979473}

Our Themes	Mental health	Early childhood development and learning	Community connectedness and vulnerability	Active living
	We are committed to fostering and maintaining good mental health in Latrobe. This includes, but is not limited to, projects helping people to receive better care, support and sense of community.	We are committed to providing all children in Latrobe with a strong start to life. This includes, but is not limited to, projects related to early childhood development, equity, education and overall wellbeing.	We are committed to creating opportunities for everyone in Latrobe to connect and participate. This includes, but is not limited to, activities focussed on social connection, pride of place, marginalised communities, accessibility, inclusion and safety.	We are committed to encouraging and enabling healthy, active lifestyles in Latrobe. This includes, but is not limited to, projects relating to physical activity, food security, nutrition and related service provision.

Share your idea: Provide a brief summary of your idea - why is it special, what is it and who will deliver the activity.
{field:share_your_idea_1713318121844}

Benefit to the Latrobe Valley: Briefly describe how this project will benefit the Latrobe Valley community.
{field:benefit_to_the_latrobe_valley_1713321886035}

Demonstrate your capability to deliver the event: Share skills/specialist knowledge required to deliver the event and identify if there is a specific capability gap that we can support through funding.
{field:demonstrate_your_capability_to_deliver_the_event_1713321930264}

Partners if applicable: Include the details of any partners (name and organisation) who will help to deliver this activity (if applicable).
{field:partners_if_applicable_1713322346130}

Funding and Contribution:
Amount requested from LHA: {field:total_amount_requested_from_lha_1713330337846}

Proposed budget:
{field:proposed_budget_item_1713324323013}

Will you also be utilising other funds? If so, how much and who will be contributing? Eg. Please list any other relevant grants, sponsorships etc.
{field:will_you_also_be_utilising_other_funds_if_so_how_much_and_who_will_be_contributing_eg_please_list_any_other_relevant_grants_sponsorships_etc_1713331193184}

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