Grants for Women Acquittal Form



63504953000Office Use OnlyGrant Reference NumberDate ReceivedAcknowledgedGrants for Women Program Acquittal ReportGeneral InformationGrant DetailsName of ProjectGrant Amount$Applicant’s DetailsName of organisationPostal addressSuburbPostcodeTelephone Contact Person – responsible for the daily co-ordination of the projectNamePositionTelephoneMobileEmailDeclarationI declare that the Grants for Women funding of $______________ (ex GST) provided by the Department?of Local Government and?Communities has been spent in accordance with the purpose and conditions for which it was granted and that the financial statements are a true and fair record of the transactions for this project.Name Signature PositionDateProject EvaluationPlease read all of the questions before you start writing your responses. If you feel that you will need more space than that provided, please provide attachments with your Evaluation Report.1.Briefly describe what the grant funds were expended on2.What date(s) did you run and complete your project?3.Were other partners involved with the project? Yes ? No ?If yes, please complete the table belowOrganisation NameHow the organisation was involvede.g XYZ CouncilOn organising committee, provided venue free of charge, advertising4.Which main group did each participant represent?DiversityNumber of Participants Indigenous WomenTransgender WomenSenior (60+)Women from culturally and linguistically diverse communities Women with disabilitiesYoung womenWomen working in predominately male environmentsOther (please specify)Not statedTotal5.Please comment on how successful your organisation was in achieving the following intended outcomes:The project enhanced the capacity of women’s economic independenceStrongly Agree ? Agree ? Disagree ? Strongly Disagree ? Neither ? Unsure ?The project enhanced women’s leadershipStrongly Agree ? Agree ? Disagree ? Strongly Disagree ? Neither ? Unsure ?6.Please describe the most significant change that happened for women as a result of the project.7.Please outline any challenges you faced on the delivery of your project.8.What acknowledgement has the Department of Local Government and Communities received as a result of this grant? (please attach a copy of any media release, brochures etc.)9.Please comment on the grant process and provide any comments/suggestions for future Grants for Women Program.Financial ReportingBUDGET $ACTUAL $INCOMEGrants for Women Other GrantsSponsorshipDonationsOther (include any in-kind contributions)TOTAL INCOMEEXPENDITUREEg. AdvertisingAccommodation/mealsPresenter/speakerEquipment Other (include any in-kind expenditure)TOTAL EXPENDITURESURPLUS*/DEFICIT*Any unused Grants for Women Program funds are to be returned via cheque and made out to the’Department of Local Government and Communities’. Please then post to:Grants and Contracts OfficerDepartment of Local Government and CommunitiesGPO Box R1250PERTH WA 6844 ................
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