Organisation details
Please only complete the following if you have been directed to by the DLGSC Small Grants team via email. On completion of this form, a confirmation email will be sent to the primary contact email address along with the details provided.
The WA State Government adheres to an authorised process to distribute public funds for election commitments ensuring public funds are distributed in a transparent and accountable manner. Organisations who have been nominated project or program funding as part of 2025 State Election Commitments are required to complete the following gateway information so that a grant agreement can be developed and funding released.
If you have any questions or require further information, please contact the Small Grants Team by email SR.SmallGrants@dlgsc.wa.gov.au or phone 61 8 9492 9767.
Add your social media link here.
e.g. Mr, Mrs, Ms
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Provide your Australian Business Number (ABN).
If your Organisation has no ABN, then your Organisation should contact the Australian Taxation Office (ATO) to discuss its eligibility to obtain an ABN.
A valid ABN contains 11 numbers. For example 12345678901.
This field is required
To protect against potential EFT scams and fraud, banking details MUST be confirmed by the payee as an added security measure. If you have not received any payments from DLGSC previously or your bank details have changed, please provide a recent bank statement (within the last 6 months) below. Payments cannot occur until banking details have been confirmed.
Enter BSB as 6 numbers separated by a dash, for example 633-000.
Numbers only, do not include space or dash.
If you are a new organisation or have changed your bank details, please download and complete our Supplier (Payee) Creation and Amendment Form.
This is required for all New Organisations or Updated Bank details
Evidence provided must clearly display the BSB, Account number and Account name (MUST match the organisation name). This should be a bank statement, proof of balance or screenshot from internet banking.
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Examples: local government, other grants, self-funded.
2 or 3 sentences (max 1000 characters)
What is the address, suburb, postcode where the project will be delivered?
Please separate multiple activities with a comma. Up to 5 activities can be included.
As this funding has been provided as part of a Western Australian Government election commitment, it is a requirement that the WA Government is appropriately acknowledged in any public communications, signage or promotional material related to the funding. Further information, including specific acknowledgment requirements and approval processes for materials will be provided at a later date.
The organisation acknowledges and agrees that this Agreement and information regarding it is subject to the Freedom of Information Act 1992 and that the Grantor may publicly disclose information in relation to this Agreement, including its terms and the details of the Organisation.
Any information provided by you to DLGSC can be accessed by you during standard office hours and updated by writing to DLGSC or calling the DLGSC office listed below.
All information provided on this form and gathered throughout the election commitment delivery process will be stored on a database that will only be accessed by authorised departmental personnel and is subject to privacy restrictions.
I certify that the information supplied is to the best of my knowledge, true and correct.
I certify that I have the authority, as vested by the Board/Committee/Council/CEO, to submit this application by electronic transmission.
If you have any questions or require further information, please contact the Small Grants Team by email SR.SmallGrants@dlgsc.wa.gov.au or phone 08 9492 9767.
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