Grants Application Form

Apply now to receive funding to raise awareness of viral hepatitis in your local community.

Applicant Details
Contact Name(Required)
First Last
Organisation Name(Required)
ABN(Required)
Postal Address(Required)
Address Line 1 Address Line 2 City/Town State Postcode
Phone Number(Required)
Email Address(Required)
Enter Email Confirm Email
What does your organisation/group do? (50 words max)(Required)
Please attach any supporting documents such as a service leaflet or a website link as needed.
File
Max. file size: 50 MB.

Evaluation and Budget
Event evaluation(Required)
How will you measure the success of this activity?
Grant amount requested(Required)
- $1000
- $500
Event Budget(Required)
Please provide a high-level description of how the grant funds will be used.
Item Amount
Are there any other organisations involved with your project?
Name of partner/stakeholder Their contribution
Will you receive any other financial support (including in-kind support)?
Description Amount/value
Submission
I certify that all monies provided under the Hepatitis Queensland World Hepatitis Day Grants Program in relation to this application will be used for the purposes set out above only(Required)
- Yes
- No
I certify that we will fullfill all reporting requirements by Friday 5th September 2025(Required)
- Yes
- No
Media Consent
By submitting this application, you acknowledge and agree that any photos, videos, or other media provided to Hepatitis Queensland as part of this grant may be used for promotional and educational purposes. This includes but is not limited to use on our website, social media channels, publications, and other communication materials. If you have any concerns or wish to place restrictions on how your media is used, please contact us on 07 3846 0020 or digital@hepqld.asn.au.
Name(Required)
First Last
Postion(Required)
Date(Required)
DD slash MM slash YYYY
CAPTCHA

Item	Amount

Name of partner/stakeholder	Their contribution

Description	Amount/value

Applicant Details