Fillable - 001369 - Community Pride Application Form ƒa (Central Hawkes Bay District Council New Zealand)

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- 001369 - Community Pride Application Form ƒa (Central Hawkes Bay District Council New Zealand)

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COMMUNITY PRIDE & VIBRANCY FUND APPLICATION FORM
1
PURPOSE
The Community Pride and Vibrancy fund seeks to support community opportunities
to create pride and vibrancy in Central Hawke’s Bay. The fund support projects that
are an activity, programme or development that will occur in a public space and
promotes our Community to THRIVE.
Successful applications will result in outcomes that support our communities
identity, attract people’s interest, inspire and engage people and overall, contribute
to a sense of community.
Applications to the fund may not always be monetary and could include
the provision of materials, labour or other support.
If you need more information about the Community Pride and Vibrancy Fund or want help filling
out this form please contact Council by phoning 06 857 8060, or emailing funding@chbdc.govt.nz
COMMUNITY PRIDE & VIBRANCY FUND APPLICATION FORM
2
GENERAL DETAILS
Name of Organisation/Group:
Postal Address:
Street Address:
Email:
Contact Person:
Contact Phone Number:
Contact name of at least one other person who we can contact if we need more information.
Under the Privacy Act (1993) you must ask permission from these people before giving their details.
Name:
Phone (day):
(eve):
Name:
Phone (day):
(eve):
TELL US ABOUT YOUR PROJECT, EVENT OR ACTIVITY
1. What is the project, event or activity you are seeking funding or resourcing for?
Please give a brief description including where and when your project, event
or activity will take place.
2. How will your programme, event or activity add to a sense of pride and vibrancy
in our community?
COMMUNITY PRIDE & VIBRANCY FUND APPLICATION FORM
3
3. Will the provision of this project, event or activity resolve a local issue facing the
community? If yes, please describe.
4. Does your project, event or activity link to Community Planning in your area?
If yes, please describe.
5. Tell us about the key people and/or community involved.
COMMUNITY PRIDE & VIBRANCY FUND APPLICATION FORM
4
6. How many participants do you estimate will participate in your project, event or activity.
FINANCIAL INFORMATION
1. What is your organisations legal status? (If applicable)
2. If a registered charity, please supply your charities commission registration number.
3. If you do not have a legal identity, please explain why. Eg Individual or informal group.
4. If you are a formal group or organisation, are you registered for GST? Yes No
If yes, write your GST number here: ££ £££ £££
If you are registered for GST please do not include GST in your budget.
COMMUNITY PRIDE & VIBRANCY FUND APPLICATION FORM
5
5. Please attach a detailed budget for your project, event or activity including both
income and expenditure.
6.
What level of funding are your requesting from the Community Pride and Vibrancy Fund?
$
7. Tell us about any other funding you have applied for or received for this project,
event or activity.
Date Applied:
Source of Funding:
Type of Funding (eg Grant):
Date of Result:
Amount applied for or received:
DECLARATION
PLEASE TICK
I/We hereby declare that the information supplied in all sections of this application are true
and correct to the best of my/our knowledge.
I/We have the authority to commit our organisation/group (if applicable) to this application
to the Central Hawke’s Bay District Council Community Pride and Vibrancy fund.
All reasonable information has been provided to support our application
I/We will forward a report on the success of the project to Central Hawke’s Bay District Council
no later than 2 months after completion of the project, event or activity.
We will provide Central Hawke’s Bay District Council with imagery and updates from our
activities for social media/marketing promotion.
We understand that Central Hawke’s Bay District Council:
Is bound by the Local Government Official Information and Meetings Act 1987
I/We consent to it recording the personal contact details provided in this application,
retaining and using these details.
I/We understand that our name and brief details about the project, event or activity may
be released to the media or appear in Council documentation.
I/We undertake that we have obtained the consent of all people involved to provide these
details. We understand that we have the right to have access to this information
This consent is given in accordance with the Privacy Act 1993.
COMMUNITY PRIDE & VIBRANCY FUND APPLICATION FORM
6
Person 1
Name:
Signed:
Position:
Date:
Person 2
Name:
Signed:
Position:
Date:
FINAL CHECK
Completed all the sections of this application
Provided financial details including a copy of your latest financial statements
(if any) and a detailed budget
Attached supporting documents including letters of support for your project,
event or activity
Please post or deliver this application to:
Community Pride & Vibrancy Fund
Central Hawke’s Bay District Council
Ruataniwha Street, Waipawa P O Box 127
Waipawa 4240
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- 001369 - Community Pride Application Form a (Central Hawkes Bay District Council New Zealand)

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Completed 4 August 2020

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