Royal Agricultural Society of NSW Foundation

The 25,000 Question (25KQ)

Application Form 2008

Section 1. Your Details

Full Name *

Street Address: *

Phone:

Mobile:

Email Address: *

Local Show society: *

Are you a current or previous: ShowGirl: Rural Achiever:

* = required fields

Section 2. Summary of your idea

In less than 250 words, please respond to this question: ‘If you had $25,000 to address a need or issue in your local community, what need/issue would you choose and how would you go about addressing it?’

Section 3. Further Information

Please give us a little more detail on the project for which you are seeking funding.

Community Partner Details

Which local organisation is your Community Partner for this project (i.e. responsible for overseeing implementation and use of funds)?

Name of Organisation:

Address:

Contact Person and Position:

Phone:

Fax:

Email:

How will this organisation be involved in the project?

b) Project Details
Please respond to each question below in less than 100 words:

What is the name of your project?
What is the problem, issue, cause or need that your project aims to address?
What does your project plan to do to address this problem, issue, cause or need?
Who will benefit from the project? (Please include the number of people assisted.)
How will the project bring benefit to the community?
Will volunteers have a role in this project? (If yes, how many?)
Are there many risks involved in this project? (What might they be?)
Will the project need ongoing funding into the future? (If yes, how will it be funded?)
How will you know/measure if your project is a success?
List up to three outcomes are you hoping to achieve:
How much will it cost to complete the project? (Please provide a budget of all anticipated costs).

Please provide the names and contact details of two referees who may be contacted by the RASF, if necessary, for a reference regarding your suitability for an Award. You do not need to ask them to provide a written reference for you.

Referee 1

Name:

Address:

Phone:

Mobile:

Email:

Relationship to applicant:

Referee 2

Name:

Address:

Phone:

Mobile:

Email:

Relationship to applicant:

Section 4. Any Other Information

Is anything else that you would like to communicate that has not been covered previously? If yes, please provide this information in no more than 150 words.

Agree to Declaration?

Privacy Act Statement:

Information, personal or otherwise, provided by you on this Application Form is to be used for the purpose of processing your application and any associated activity relating to the application, processing and administering your project, for RASF and RAS promotions including media activities and for archival purposes. The information will remain confidential at all times except for disclosure which you have consented to or which is required by law. You may request access to your information and request that it be corrected at any time or the facility cancelled by advising the Privacy Officer on 9704 1111.