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* 1. Organisation/ Group name

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* 2. Contact person (first and last name)

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* 3. Contact person email

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* 4. Contact person phone number

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* 5. Postal address

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* 6. State/Territory

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* 7. Organisation/group overview

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* 8. Is your organisation/group incorporated?

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* 9. If no, please provide name and contact person's details of auspicing agency?

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* 10. Organisation's/Group's ABN

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* 11. Is the organisation/group registered for GST (Goods and Services tax)? Please
refer to the Guide to determine GST status.

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* 12. Please provide an overview of your proposed dementia-friendly communities project.

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* 13. How does your project meet the aims of the Community Engagement Program?

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* 14. How does your project incorporate the key principles of dementia-friendly communities?

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* 15. How will your project include people living with dementia and their carers in the design and delivery of the project?

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* 16. What partnerships will be formed to deliver the project? Please note any formal or informal collaborations. 

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* 17. Will your project serve one or more of the diverse priority groups? Please provide details.

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* 18. If there is any other relevant information about this dementia-friendly communities project, please share it here?

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* 19. What level of funding are you seeking?

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