Adult Learners Week grants application form1 – 8 September 2016

Applications are due to training.nt@nt.gov.au by Monday 1 August 2016.

Adult Learners’ Week – Grants Application Form

Section 1: Applicant contact details

Organisation 1Name of organisation:

Postal address:

ABN:

Contact person: Position:

Phone number: Mobile:

Email:

Type of organisation (please tick):Registered Training Organisation Incorporated Association

Community Organisation Registered Charity

Industry Association Other (please specify)

Organisation 2Name of organisation:

Postal address:

ABN:

Contact person: Position:

Phone number: Mobile:

Email:

Type of organisation (please tick):Registered Training Organisation Incorporated Association

Community Organisation Registered Charity

Industry Association Other (please specify)

The organisation holds $10 million public liability insurance that covers the scope of the event, for the period specified in this application.

YesNo

(Please add contact details of other partner organisations as required)

Section 2: Project proposal

Program Name:

Location of Program:

DEPARTMENT OF BUSINESSPage 1 of 5 June 2016

Adult Learners Week grants application form

Adult Learners’ Week – Grants Application FormTarget Group:

Attendees: Male Female Total

(Provide detailed responses to all questions that are applicable to your application. Supporting documentation may be attached. The Adult Learners’ Week Funding Information and Guidelines should be used as a guide to aid your application.)Program description and objectives

1. Outline the proposed program and the rationale for its design. For example, why is the program necessary? How will the program benefit the community? What does the program aim to achieve for Adult Learners’ Week? Is the program linked to any existing programs?

2. How does the program meet the individual needs of adults or the community?

3. What are the main skills that participants will gain?

4. What are the learning outcomes for participants at the completion of the program?

5. Is the proposed activity consistent with the national Adult Learners’ Week theme?

6. How will these learning outcomes be monitored and evaluated?

DEPARTMENT OF BUSINESS Page 2 of 5June 2016

Adult Learners Week grants application form

Adult Learners’ Week – Grants Application Form

Partnership agreement (if applicable)1. Provide details of contribution/support from the partners involved in this program.

For example, how will each partner contribute to the running of the program – in kind or financial support, time, resources etc. Include detail of any consultation or collaboration with key stakeholders.

2. Will this program utilise supplementary funds or resources from other Australian or Northern Territory Government programs?If yes, please provide details.

3. Does this program have links to broader community development opportunities?If yes, please provide details. For example is there potential for the program to be used as a model for delivery to other groups? Will it develop resources that can be made available to future clients? Will it create enterprise development opportunities?

Education support (if applicable)1. What literacy and numeracy support will be available to participants?

2. How will the literacy and numeracy support be delivered to participants?

DEPARTMENT OF BUSINESS Page 3 of 5June 2016

Adult Learners Week grants application form

Adult Learners’ Week – Grants Application Form

Promotion1. How will you promote your program/activity?

2. How will the program promote Adult Learners’ Week and encourage Territorians to participate in lifelong learning?

3. How will the program improve community awareness of the role and importance of adult learning?

BudgetDetails Cost GST Total

Total

Supporting documentationSupporting documentation attached: Yes No

Number of pages attached:

DEPARTMENT OF BUSINESS Page 4 of 5June 2016

Adult Learners Week grants application form

Adult Learners’ Week – Grants Application Form(Please give details of supporting documents if applicable.)

Signed (Applicant and Partner Organisation/s)Should this application be successful, we the undersigned hereby agree that details relating to the approved program may be publicly released by the Department of Business

Organisation Contact Name Signature Date

1.

2.

(Note: add additional rows if required.)

Section 3: Event detailsPlease note all funded organisations will have the details of the activity automatically added to the online and printed calendar of events. Organisations that do not wish to be listed should advise here:

Yes, please include event details on the Adult Learners’ Week calendar of events

No, please do not include event details on the Adult Learners’ Week calendar of events

All details provided in the Event Details section will be included in the 2016 Adult Learners’ Week calendar of events. Any amendments to these details must be provided no later than close of business Friday 12th August 2016.Title of Event/Activity:

Name of Contact:

Telephone:

Email (optional):

Venue (street address):

Date: Time and approximate duration:

Maximum number of participants: Participants costs (if any)

Brief description of event: (max 100 words)

DEPARTMENT OF BUSINESS Page 5 of 5June 2016