Shark Pitch

Expression of Interest Form

Organisation Information
Organisation Name*
Physical Address*
Street Address Address Line 2 City State Postcode Country
ABN Number*
Email*
Website Address
Facebook
Person applying for EOI*
First Last
Position in organisation*
Phone*
Email*
CEO or Senior Manager Name*
First Last
Phone*
Email*
Annual Income
- Tick if you can confirm that your organisation’s average annual income over the last three years is below $1 million.
Number of people who benefited from your services in the past year*
List the specific geographic areas covered by your organisation*
Describe your organisation and what it does*
Maximum 100 words.
Upload a copy of your latest strategic or business plan, if you have one
Max. file size: 128 MB.
Upload a copy of your latest financial statement or annual report
Max. file size: 128 MB.
Upload your organisation's logo
Max. file size: 128 MB.
High resolution (5MB maximum).

Presenter details
Presenter name*
First Last
Presenter position*
Presenter availability*
- Tick to confirm that your presenter will be available in Portland on Tuesday 7 September 2021.
Upload a profile photo of your presenter
Max. file size: 10 MB.
High resolution (10MB maximum).
Provide a short biography of your presenter*
If selected, this will be used on electronic and printed materials. Maximum 100 words.

Project Details
Describe the project you want to raise funds for
The more tangible you can be the better. Be explicit about what exactly this funding will pay for, and what that will do for your organisation or your programs. If selected, this text is printed on Electronic and printed materials. Maximum 100 words.
How much will this project cost in total?
Maximum 50 words. Please provide a simple breakdown.
How many people would funds raised, impact? Who are they and what difference could this project make in their lives?
Maximum 100 words.
What are the expected outcomes and how will you measure them?
Tell us of any plans to formally evaluate the impact of this project or activity. If not, then include 3 simple key indicators that you plan to use to measure success and how you intend to collect the data (participant interviews, pre/post surveys, professional observation, other).
Please list your existing significant funders
What are your plans to sustain funding beyond this grant?
Maximum 50 words.
What other pro-bono services or in-kind goods do you need?
Maximum 50 words.

Accountability and Evaluation
All successful applicants must complete the United Way Glenelg Evaluation Report at the completion of the program of when the funds have been used. The Evaluation Report requires evidence of expenditure of all funds through the provision of receipts, ledger reports, etc. The evaluation must be received in the time outlines by United Way Glenelg.
The CEO or Senior Manager must be able to complete the Evaluation Form at the conclusion of the program being funded if the person applying for the grant in your organisation is no longer employed.
Privacy
In some circumstances different agencies can have similar requests for funds. In this situation are you happy for the sharing of information between agencies*
- Yes
- No