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Patronage Application Form

With the many patronage requests received by the Governor, it is necessary to provide supporting documentation to assist patronage consideration.

Requests for the Governor to be patron of an organisation should include the following supporting documentation:

  • Recent annual report (if published) or statement of the organisation’s activities (if no annual report is available)
  • Recent financial statements, giving evidence of financial stability
  • Evidence of longstanding and continuity (at least five years), and a sustained record of achievement
  • Suggestions of how the organisation would involve its patron in its activities

Download Form

Cover letter

If you wish to provide a formal cover letter with this application please upload it here

Administrative details

Is this a private or an office number?

On which basis is Vice Regal Patronage being sought?

Organisation Declaration

I confirm that the information being provided is true and accurate. I understand that any inaccurate or incomplete information may impact on the decision by Government House Western Australia to recommend Vice Regal support to my organisation.