FundAssist

Part 1 - Contact Details

Name:	*
Postal Address:	*
Telephone:	Please enter number without spaces *
Facsimile:	Please enter number without spaces *
Email:	*

Part 2 - Experience
Please provide information about position(s) you have held that included the preparation of funding applications submissions (you must demonstrate at least 2 years of relevant experience).

				Position Involved
Position Title	Organisation	Start (mth/yr)	Finish (mth/yr)	Preparation of funding applications (Y/N)	Assessment of funding applications (Y/N)
					*

Provide details about up to 5 of the funding applications/submissions that you have completed. Try to provide information that illustrates the range of projects you have undertaken (eg. large and small, different funding sources, different projects).
Project Title	Year App completed	Funding Source(s) eg Program Name	Funding amount sought (approx)	Funding amount granted (approx)

List any funding programs with which you feel you have particular expertise:

Do you presently work for a private company that provides funding application/submission services? (If 'yes', please supply the name of the firm)

If yes enter firm name here *

Note any other information that you feel may be relevant.

If you are selected as an Associate, would you like to have a short bio placed on our website? Your answer will not affect your application)