Community Investment Application Form

Before you start completing your application, please note:

Funding proponents must be able to meet Chalice’s expectations of its partners including complying with laws and regulations such as applicable competition, consumer protection, environmental, employment, modern slavery, health, safety and welfare laws.

Our application form cannot be saved as you progress so we recommend reviewing the form in full and gathering all of your responses and required information before starting.

Please ensure you complete each field. If the question is not applicable – simply write ‘n/a’ or similar to indicate this field does not apply to your application.

Sponsorship Application Form

If you are unable to apply online or are having difficulties with your application, please call Chalice Mining on (08) 9322 3960 (Mon-Fri 9am to 5pm).

Supported sponsorships and funding will be formalised in a sponsorship agreement between two parties.

"*" indicates required fields

Section 1. Application Details

Legal name of entity requesting sponsorship*

Contact Person*

test

Position*

Phone*

Email*

Postal Address*

ABN/ACN*

Web/Social media Address*

Please provide name and contact details on key parties involved with your initiative? E.g. committee members, board members, president etc.*

Section 2. Community Investment Details

a. Type of contribution requested*

Grants Monetary contribution to help the community by supporting local activities and building community initiatives.

Sponsorships Commitment of money or resources in exchange for specific promotional benefits.

In-kind Support Non monetary contribution such as volunteer support, supply of services or goods.

b. Focus area*

Education Initiatives that advance and improve regional educational opportunities.

Environment Initiatives that protect and rehabilitate the environment.

Community Connection Supporting local opportunities, events and groups to strengthen the community connection within the region.

c. Brief description and purpose of the initiative*

d. How does your application support our focus areas of Education, Environment or Community Connection?*

e. How is your group or organisation linked to the local community in which Chalice operates?*

f. Description of the investment proposal?*

g. What benefit the initiative will provide to the local community?*

h. Please provide examples of how your organisation/event supports diversity, equity and inclusion?*

i. Amount of funding requested from Chalice (cash amount and/or charitable donation), plus the overall amount of funding required to fulfill the initiative?*

j. When is the sponsorship/donation required?*

k. Are any other individuals or organisations supporting the initiative? Please provide details*

l. What specifically will the funds be used for?*

Section 3. Opportunities

a. Detail any associated benefits and/or opportunities in relation to the following areas:

Benefit / opportunity for Chalice

Explanation

Level of Status (e.g. naming rights, gold sponsor etc)

Level of Status (e.g. naming rights, gold sponsor etc)*

Use of Chalice’s intellectual property (e.g. logos, marks, talent appearances and/or imagery)

Media/communication opportunities (e.g. TV, print, radio, internet, newsletters)*

Media/communication opportunities (e.g. TV, print, radio, internet, newsletters)

Use of Chalice’s intellectual property (e.g. logos, marks, talent appearances and/or imagery)*

Branding & Signage opportunities

Branding & Signage opportunities*

Tickets/Hospitality

Tickets/Hospitality*

Chalice staff involvement

Chalice staff involvement*

b. If you are successful in your application, please confirm you will be able to provide a report / photo of the impact?*

Yes

c. Do you give permission for Chalice to use any quotes or photos in publicly available documents?*

Yes

Upload any supporting material here (pdf or image formats only)*

Accepted file types: jpg, gif, png, pdf, Max. file size: 5 MB.

Upload requirements

Chalice reserves the right to ask any further questions which may be needed to assess your application.*

I acknowledge that I have checked the information provided and have added all the relevant information

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Phone

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