MyState Foundation – Grant Application Form

General Information
The collection, use and disclosure of personal information by MyState Foundation is described in the document Privacy Policy which is available at mystate.com.au; at any MyState Bank branch, or by calling 138 001.
Full name of organisation*
Organisation ABN*
CEO/Manager name*
Upload Deductible Gift Recipient (DGR) Status endorsement from the ATO*
Accepted file types: pdf.
If you do not have DGR status you will not be eligible for a grant. You can use ABN Lookup to search your organisation and find your deductible gift recipient status. This form can be downloaded and saved as a PDF.
Upload a copy of your Certificate of Incorporation
Accepted file types: pdf.
If your organisation is not incorporated do not upload anything here.
Is your organisation Income Tax Exempt?*
- Yes
- No
Contact Person
You will be the contact person for your MyState Foundation grant application. You must be available to be contacted by the Foundation during business hours.
Your title?*
- Mrs
- Ms
- Miss
- Mr
Your first name?*
Your last name?*
Your best contact phone number?*
Your email address?*

Organisation Registered Office
Street Address*
Street Address Address Line 2 City State Postcode
Postal Address (if different from above)
Street Address Address Line 2 City State Postcode
Organisation website address?*
Organisation email address?*
Organisation Local Office
(Complete only if your head office is located outside of Tasmania)
Street Address
Street Address Address Line 2 City State Postcode
Postal Address (if different from above)
Street Address Address Line 2 City State Postcode
Permission to contact – Declaration
I (the contact person) give permission for MyState Foundation to use the private details within this application to contact our organisation regarding information which the Foundation considers to be useful to our organisation.
- Yes

General Information