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                         (Outgoing) Sponsorship Authorisation Form 
        This form sets out the relevant information which should be considered in evaluating and 
        approving an Outgoing Sponsorship, and provides a record of approvals required to proceed 
        with the establishment of a sponsorship arrangement.
        The Sponsorship Overview section of this form provides a broad overview of the sponsorship 
        proposal. It identifies who will be responsible for managing and funding the sponsorship, and 
        details what is being proposed.
        Part A of this form (Sponsorship Initiation) must be completed for sponsorships which are 
        initiated within the Department of Health or Health Service Providers (collectively, the WA 
        health system). It documents specific details of the opportunity to be the subject of an outgoing
        sponsorship, and considers the suitability of a sponsorship in the context of that opportunity. It 
        also includes a section for sign off (Sponsorship Initiation Approval), which provides a record of
        the decision to further consider a proposed sponsorship.  Where external parties approach the 
        WA health system with an offer of sponsorship, Part A of this form does not need to be 
        completed, and may be deleted from the template.
        Part B of this form evaluates the suitability of the proposed sponsorship, and documents 
        authorisation to establish a sponsorship arrangement. Note that as part of the process of 
        obtaining Part B sign-off, approval from the Minister for Health, and/or the relevant highest 
        authority within the organisation (the Board of Management or Chief Executive Officer) may be
        required in some instances.
        Within the forms below: 
        Guidance Notes have been provided in red text, and provide relevant information in completing
        the forms. They should be deleted once the form is completed.
        Response descriptions have been provided in blue text to assist in preparing appropriate 
        responses. This text describes the response required, and should be replaced with the actual 
        information described.
        Sponsorship Overview
        This Sponsorship Overview section identifies who and will be responsible for managing and 
        funding a proposed sponsorship, sets out at a high level, the sponsorship opportunity or 
        purpose for consideration.
        Sponsorship Manager
         Sponsorship Manager           Name
         Title                         Position 
         Division / Branch / Section
         (The Sponsor)
         Funding Source                The Division / Branch / Section providing the sponsorship 
                                       funding
        Outgoing Sponsorship Overview                                   1 | P a g e
          Contact Details                   Phone Number:
                                            Email:
         Sponsorship Proposal
          Sponsorship Purpose               This section identifies the intended purpose of the 
                                            sponsorship and its merits.
                                            Identify the Event/Program/Other Activity which is being 
                                            considered for sponsorship, along with its purpose, goals 
                                            and intended outcomes.
          Sponsorship Alignment             Describe how this sponsorship aligns with the mission, 
                                            vision or objectives of the WA health system.
          Other Notes / Considerations /    Note any other information or factor relating to the 
          Risks                             Recipient which is relevant in planning for or evaluating the
                                            suitability of the sponsorship.
                                            E.g.: Any notable activities the Recipient is involved in, or 
                                            general reputation
         Outgoing Sponsorship Overview                                            2 | P a g e
         Part A – Sponsorship Initiation
         [For Internally Initiated Sponsorships Only]
         This Part A – Sponsorship Initiation considers the merits and feasibility of a sponsorship 
         opportunity, and whether it should be further considered, and is used to provide approval to 
         undertake more detailed work developing a sponsorship arrangement. 
         It records the details of a potential sponsorship opportunity which is initiated by an entity within
         the WA health system, and must be completed and approved (in the Sponsorship Opportunity 
         Approval sign-off section below) prior to approaching a potential Sponsorship Recipient(s).
         This Part A – Sponsorship Initiation, and corresponding Sponsorship Initiation Approval does 
         not need to be completed (and may be deleted) where the Sponsorship is initiated by an 
         external party seeking sponsorship from an entity within the WA health system.
          Proposed Recipient(s)               Identify the proposed Recipient(s) for which sponsorship is 
                                              being considered.
                                              If the Sponsorship opportunity will be provided to the 
                                              market/community generally to apply for, specify the 
                                              mechanism for engaging with the market/community.
          Proposed Recipient(s)               Provide details of key information about the proposed 
          Description                         Recipient(s) which would be relevant for considering 
                                              appropriateness of association with the Sponsor.
                                              E.g.: Who they are, what they do, their goals, mission, and 
                                              objectives.
                                              It may also be relevant to consider the Recipient’s 
                                              reputation, associations, and any activities it may be 
                                              undertaking or affiliated with.
          Sponsorship Value                   Specify what will be provided to the Recipient’s 
                                              activity/event.
                                              For non-monetary contributions, estimate the market value 
                                              of the contribution. 
          Proposed Sponsorship Term           Single Event (Specify this if the sponsorship is for a 
                                              discrete event or activity, and the sponsorship will be 
                                              provided in a lump sum or at a single point in time.
                                              Or
                                              [Specify Term] (If the sponsorship will be provided or 
                                              applies over a period of time, specify the period of time for 
                                              which the sponsorship will need to be managed)
         Part A | Outgoing Sponsorship Initiation                                     3 | P a g e
          Proposed Reciprocal Benefit         Specify what reciprocal benefit will be requested from the 
                                              Recipient 
                                              E.g.: Recognition of our sponsorship through display of 
                                              Departmental logo or other permission to advertise at the 
                                              sponsored event.
                                              Note: Refer to the Communications Directorate for 
                                              guidance on the use of the State Badge / Department logo 
                                              for these purposes.
          Other Notes / Considerations /      Specify any other matters which should be considered or 
          Risks                               taken into account in relation to the sponsorship 
                                              opportunity.
         Sponsorship Initiation Approval 
         [For Internally Initiated Sponsorships Only]
         This approval is required to proceed with sponsorship opportunities initiated within the WA 
         health system as identified in the Sponsorship Initiation section above. It does not need to be 
         completed (and may be deleted) for Sponsorships initiated by an external party seeking 
         sponsorship from an entity within the WA health system.
          Approved:                                         Not Approved: 
          Comments:
          Sign Off:     Name
                        TITLE
                       Refer to the applicable Authorisations Schedule to identify the authorised officer 
                       able to provide sign-off where approval is required.
         Part A | Outgoing Sponsorship Initiation                                     4 | P a g e