Fillable CCS-Application-Form Creative Communities Scheme Application Form

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CCS-Application-Form Creative Communities Scheme Application Form

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Whangarei
District
2!-4~~
~Bkii•k'!nz
COMMUNITIES
Whangarei
District Council
Creative Communities Scheme
Application Form
Funding for local arts projects
Ngā pūtea mō ngā toi te haukāinga
Please refer to the current closing dates at www.wdc.govt.nz/funding.
Email your application to: funding@wdc.govt.nz
Or post to: Community Funding
Whangarei District Council
Private Bag 9023
Whangarei 0148
Contact: Cindy Velthuizen
Community Funding Officer
Phone 09 430 4200
Creative Communities Scheme Application Form 1
BEFORE YOU START
Read the Creative Communities Scheme Application Guide
Before you prepare your application you should read the Creative Communities Scheme Application
Guide. This guide tells you:
whether you are able to apply for Creative Communities Scheme funding for your project
which projects and costs are eligible and ineligible
what information you will need to include in your application
Complete the Creative Communities Scheme Application Form
Applications can only be submitted using this document
This form is designed to be typed in to. The answer boxes will expand as you type.
Example:
Type your answer here
Signing the form – please print the declaration page and sign it, then scan and email back to us
along with your application. If you are not able to scan your signed page, please post or drop in
your application to Whangarei District Council at either Forum North, Walton Plaza or Ruakaka
service centre.
IMPORTANT – DO NOT edit any text outside of these boxes
If you are unable to type into the boxes provided, please print a copy and complete by hand
If you need more space, attach information to the back of this application form. Include the section
headings to help assessors.
We recommend that you keep a copy of your completed application for your own reference.
Contact the CCS administrator if you need advice on your application (see contact details on the
cover page).
Before submitting your application, complete this checklist:
(mark with an X)
I have read and signed the declaration
I have made a copy of this application for my records
My project has an arts or creative cultural focus
My project takes place in the local authority district that I am applying to
I have answered all of the questions in this form
I have provided quotes and other financial details
I have provided other supporting documentation
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APPLICANT DETAILS
Name and contact details
Individual
Group
Full name of applicant:
Contact person (for a group):
Street address
Postal address (if different)
Suburb:
Postcode:
Email:
Telephone (day):
Town/City:
Country:
New Zealand
All correspondence w ill be sent to the above email or postal address
Name on bank account:
GST number:
Bank account number:
If you are successful, your grant w ill be deposited into this account, upon receipt of an invoice. Bank account name and
applicant name must match. ATTACH a bank deposit slip or other evidence of your bank account to this application.
Ethnicity of applicant/group (mark with an X, you can select multiple options)
New Zealand European/Pākehā:
Detail:
Māori:
Detail:
Detail:
Pacific Island:
Asian:
Detail:
Detail
Middle Eastern/Latin American/African:
Detail:
Other:
How did you hear about the Creative Communities Scheme? (select ONE and mark with an X)
Council website
Creative NZ website
Social media
Council mail-out
Local paper
Radio
Council staff member
Poster/flyer/brochure
Word of mouth
Other (please provide detail)
Creative Communities Scheme Application Form 1
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PROJECT DETAILS
Project name:
Brief description of project:
Project location, timing and numbers
Venue and suburb or town:
Start date:
Finish date:
Number of active participants:
Number of viewers/audience members:
Funding criteria: (select ONE and mark with an X)
Which of the schemes three funding criteria are you applying under? If your project meets more than
one criterion, choose the one that is the project’s main focus.
Access and participation: Create opportunities for local communities to engage with, and
participate in local arts activities
Diversity: Support the diverse artistic cultural traditions of local communities
Young people: Enable young people (under 18 years of age) to engage with, and participate in
the arts
Artform or cultural arts practice: (select ONE and mark with an X.)
Craft/object art
Dance
Inter-arts
Literature
Music
Ngā toi Māori
Pacific arts
Multi-artform (including film)
Theatre
Visual arts
Activitybest describes your project? (select ONE and mark with an X)
Creation only
Presentation only (performance or concert)
Creation and presentation
Presentation only (exhibition)
Workshop/wānanga
Cultural tradition of your project (mark with an X, you can select multiple options)
Detail:
European:
Māori:
Detail:
Pacific Island:
Detail:
Asian:
Detail:
Middle Eastern/Latin American/African:
Detail
Other:
Detail:
Creative Communities Scheme Application Form 2
PROJECT DETAILS (budget)
Project details
The boxes below will expand as you type. If you are completing this application by hand you may need
to expand these boxes before you print this form and/or add additional sheets. If you do, please clearly
label these additional sheets using the headings below.
1. The idea/Te kaupapa: What do you want to do?
2. The process/Te whakatutuki:
How will the project happen?
Creative Communities Scheme Application Form 3
PROJECT DETAILS
3. The people/Ngātāngata: Tell us about the key people and/or the groups involved.
4. The criteria/ Ngā paearu:
Tell us how this project will deliver to your selected criterion:
access and participation, diversity or young people.
Creative Communities Scheme Application Form 4
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PROJECT DETAILS (budget)
5. The budget/Ngā pūtea
See the CCS Application Guide for more detail on how to complete this section.
Are you GST registered?
Yes
No
Do NOT include GST in your budget
Include GST in your budget
Project costs
Write down all the costs of your project and include the details, eg materials, venue
hire, promotion, equipment hire, artist fees and personnel costs.
Item eg hall hire
De tail eg 3 days’ hire at $100 per day
Amount eg $300
Total Costs
$
Project Income
Write down all the income you will get for your project from ticket sales, sale of
artwork, other grants, donations, your own funds, other fundraising. Do not include
the amount you will be requesting from CCS.
Income eg ticket sales
De tail eg 250 tickets at $15 per ticket
Amount eg $3,750
Total Income
$
Costs less income
This is the maximum amount you can request from CCS
$
Amount you are requesting from the Creative Communities Scheme $
Creative Communities Scheme Application Form 5
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PROJECT DETAILS
Other financial information
Tell us about any other funding you have applied for or received for this project (remember you can’t
receive funds for your project from both CCS and Creative New Zealand’s other funding programmes).
Date applied Who to How much
Confirmed/
unconfirmed
Tell us about other grants you have received through the Creative Communities Scheme in the past
three years.
Date Project title
Amount
received
Project
completion
report submitted
(yes/no)
Other financial information
Groups or organisations must provide a copy of their latest financial statement. This can be a copy of
the audited accounts, an income and expenditure statement or a copy of the unaudited management
accounts.
If your group or organisation has reserves which are not being used for this project you should include
your reserves statement or policy
Creative Communities Scheme Application Form 6
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PART 3: DECLARATION
You must read and sign the following. Please place an X in each box to show that you have read the information and
agree to each section.
I/We understand that if this application is successful I/we cannot receive funds for the same project from Creative
New Zealand’s other funding programmes.
I/We declare that the details contained in this application are correct and that I/we have authority to commit to the
following conditions.
If this application is successful, I/we agree to:
complete the project as outlined in this application (or request permission in writing from the CCS Administrator
for any significant change to the project)
complete the project within a year of the funding being approved
complete and return a project report form (this will be sent with the grant approval letter) within two months after
the project is completed
return any unspent funds
keep receipts and a record of all expenditure for seven years
participate in any funding audit of my organisation or project conducted by the local council
contact the CCS administrator to let them know of any public event or presentation that is funded by the scheme
acknowledge CCS funding at event openings, presentations or performances
use the CCS logo in all publicity (eg poster, flyers, e-newsletters) for the project and follow the guidelines for use
of the logo. Logo and guidelines can be downloaded from the Creative New Zealand website:
http://www.creativenz.govt.nz/about-creative-new-zealand/logos
I understand that the Whangarei District Council is bound by the Local Government Official Information and
Meetings Act 1987
I/we consent to Whangarei District Council recording the personal contact details provided in this application,
retaining and using these details, and disclosing them to Creative New Zealand for the purpose of evaluating the
Creative Communities Scheme.
I/we understand that my/our name and brief details about the project may be released to the media or appear in
publicity material.
I/we undertake that I/we have obtained the consent of all people involved to provide these details. I/we
understand that I/we have the right to have access to this information.
This consent is given in accordance with the Privacy Act 1993
Name
(Print name of contact person/applicant)
(Print name of parent/guardian for applicants
under 16 years of age)
Signed: Signed:
(Applicant or arts organisation’s contact
person)
(Parent/guardians signature for applicants
under 16 years of age)
Date: Date:
Creative Communities Scheme Application Form 7
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