Your Neighbour Activation Scheme

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This is a preview of the Your Neighbour Activation Scheme Application Form form. When you’re ready to apply, click Fill Out Now to begin.

 

 

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Your Neighbour Activation Scheme Application Form

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Privacy Notice (Not Applicable)

We pledge to respect and uphold your rights to privacy protection under the Australian Privacy Principles (APPs) as established under the Privacy Act 1988 and amended by the Privacy Amendment (Enhancing Privacy Protection) Act 2012. To view our privacy statement, go to City of Belmont website. 

Applicant Details (Not Applicable)

Full Name * Required

First name

Last name

Address * Required

Use the arrow keys to navigate suggestions. Press Enter to select a suggestion. Start typing a name or address to see prefill options.

Return to address search

Address line 1

Address line 2

Suburb/Town

State/Province

Postcode

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Phone number * Required

Must be an Australian phone number. 

Email address * Required

Must be an email address. 

How did you hear about the scheme? Select all that apply * Required

Response required.Response required.

City of Belmont Website

City of Belmont Facebook page

Belmont Bulletin

Belmont BeNews enewsletter

Word of mouth

City of Belmont staff

other

Clear the selected value for How did you hear about the scheme? Select all that apply

Have you received a grant from the City of Belmont before? * Required

Response required.Response required.

Yes

No

Clear the selected value for Have you received a grant from the City of Belmont before?

If yes, please provide further details

Tell us about your gathering? (Not Applicable)

Date of gathering: * Required

Must be a date. 

What type of gathering are you planning to host? * Required

How many neighbours will you invite? * Required

Response required.Response required.

4 households

5 -10 households

10-15 households

15-20 households

Clear the selected value for How many neighbours will you invite?

At least 4 households required

What address will the gathering be held at? * Required

Where on the property will the gathering be held? * Required

Response required.Response required.

Front Yard

Driveway

Unit common area

Apartment common area

Other:

Clear the selected value for Where on the property will the gathering be held?

Gatherings are not permitted in backyards, on road verges, or on public roads

Please select the expenses you are seeking reimbursement for * Required

Response required.Response required.

Food

Eco-friendly plates, serviettes, cups, utensils

Drinks (no alcohol)

BBQ gas bottle refill

Games and entertainment (capped to 20% of the total amount that can be reimbursed)

Other

Clear the selected value for Please select the expenses you are seeking reimbursement for

To support the local business community, the City will only reimburse items that were purchased from shops and businesses located within the City of Belmont

Do you want to invite the Mayor or Councillor to your gathering?

Yes

No

Clear the selected value for Do you want to invite the Mayor or Councillor to your gathering?

If yes, please tell us who you would like to invite to your gathering?

Terms and conditions (Not Applicable)

I would like to know more about the City's crime prevention programs and initiatives * Required

Response required.

Yes

No

Clear the selected value for I would like to know more about the City's crime prevention programs and initiatives

I have read and agreed to the "Your Neighbour Activation Scheme" terms and conditions * Required

Response required.

Yes

Clear the selected value for I have read and agreed to the "Your Neighbour Activation Scheme" terms and conditions

 

 

The City of Belmont acknowledges the Noongar Whadjuk people as the Traditional Owners of this land and we pay our respects to Elders past, present and emerging. We further acknowledge their cultural heritage, beliefs, connection and relationship with this land which continues today.

We acknowledge all Aboriginal and Torres Strait Islander peoples living within the City of Belmont.

We wish to advise Aboriginal people that this site may contain the names, images or audio-visual recordings of people who have passed away.