Application for Neighbourhood Fund Grant1
Application for
Neighbourhood Fund Grant
1. Application details
1.1 Full name of applicant:
1.2 Physical address:
1.3 Mail address (if different from above):
Contact person:
bank name:
bank account number:
2. Application summary
2.1 Grant purpose or event name:
2.2 Date of event or that project commences: 2.3 Date funds required:
2.4 Total cost of project: 2.5 Amount requested:
3. Details of funding required
3.1 Describe the project/activity that you are seeking funding for (up to 300 words):
Application for Neighbourhood Fund Grant2
3.1 Continued:
3.2 How many people will benefit from your activity?
3.3 Is your project/activity an event?   Yes   No
Please identify 3 community benefits of your activity or event:
4. Accountability
4.1 Please list 3 outcomes by which the success of your activity/project can be measured:
5. Project budget
5.1 Please provide a budget for your activity/project (including cost breakdown):
I have attached the budget:   Yes   No
A. Total cost of project/activity $
B. Less total funds available $
C. In kind contribution $
D. Difference $
E. Amount requested $
Application for Neighbourhood Fund Grant3
5.2 How is the applicant contributing to the activity/project (resources, volunteers etc.)?
6. Declaration
I/we the undersigned declare and agree to the following:
1. The information given in this application is true and correct to the best of our knowledge.
2. I/We have the authority to commit our organisation to this proposal.
3. Any funding received will be used for the activity/project for which it is approved.
4. To participate in any funding audit of the organisation by the Invercargill City Council.
5. To complete the accountability requirements and where requested provide receipts.
6. I/we understand that failure to provide accountability reports and receipts when requested will result in our forfeiting the grant and
repaying the sum to the Invercargill City Council.
7. I/we understand that our names and details about the proposal may be released to the media or appear in publicity material.
8. We understand the Invercargill City Council is bound under Local Government Official Information and Meetings Act 1987 and details
entered in this application may be released under the act.
Full name in CAPITALS:
Date: Signature: