Let’s Light Up Football Application Form Let's Light Up Football Application Form Step 1 of 6 16% Submitting the Application Information must be entered into all mandatory fields indicated with an asterisk Click the 'Submit' button at the end of form to submit the application Once an application has been submitted, it cannot be changed The system will not allow applications to be submitted after the closing date and time Application must be completed in one sitting. Applications cannot be saved and then returned to at a late date. Suggestion, complete the application form offline, e.g. in Microsoft Word prior to beginning the online application. A preview of the application is available on the facilities website To move to the next page, click 'Next' Applications Open Tuesday 30th of April 2019 Applications close Monday 15th of July 2019, 4pm Application Details*Field is compulsory to completePlease specify whether you are a club, association, local council or school?*ClubAssociationLocal CouncilSchoolName of club, association, local council or school*Applicant Name* First Last Applicant Contact Email* Contact Phone Number*Position Held*President, Secretary, etc. Project InformationFacility Name*E.g. Valentine Sports ParkField Name*E.g Field 2Field Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Association*What local council is the facility located in?*What State Electorate is the facility located in?*Is this facility the clubs/associations home ground or an alternate venue that the club uses*Clubs Home GroundAssociations Home GroundAlternative VenueCurrent lighting status at the facility*No floodlighting currently existsLess than 50 luxBetween 50 and 100 luxBetween 100 and 200 luxUnsureProject DetailsProject Name*Is development consent required for the lighting project*YesNoOtherIf yes, evidence must be provided. See ATTACHMENTS page 4 If other, please provide further detail*Type of Lighting Project*New Floodlighting (new site)Upgrading poles and lampsUpgrading lamps onlyAdding additional polesDescribe the current lighting situation and what this project will involve?*Explain what the project will involve, i.e. number of new poles, number of new lamps, etc.Why is the project needed?*How will this lighting project benefit your club?*Anticipated project start date* Date Format: DD slash MM slash YYYY Anticipated project end date* Date Format: DD slash MM slash YYYY Financial DetailsTOTAL PROJECT COST*Total Project Cost MUST Equal Income TotalFunding1. Funding requested from Let's Light Up Football*2. Confirmed funding from Local Council*3. Confirmed funding club and/or association*If no club/association funding please enter $0 in the provided text boxINCOME TOTAL*(ADD) 1 + 2 + 3 = INCOME TOTAL AttachmentsLetter of support from local football association*Letter of support from local council*Evidence of club's contribution*E.g Bank StatementProject Quotation OR Invoice of Similar Type Project*Development consent from council or letter confirming development consent is not required*NOTE: Council letter of support can include development consent confirmationClub and/or Association Facility PlanCouncil Open Space Strategy or Similar Document Declaration By ApplicantIn submitting this application, I acknowledge that if successful, details about the project such as the applicant organisations name, project name and description, local council and amount of grant may be used by Football NSW for promotional purposesDeclaration acknowledged*Yes, I acknowledge and acceptThe declaration below must be agreed to by a person who has delegated authority to sign on behalf of the organisation. e,g. President, Board Member or authorised staff memberName* First Last Signiture is approval on behalf of the organisation to submit the application*Yes