Application for Community Grant Above $1,000
Deadline: February 12, 2021
This form is used for the Dufferin County Community Grants supporting organizations seeking
funding of more than $1,000.
Mandatory Requirements: (Pre-screening)
Applicants must be a registered not for profit or charitable organization, or partnered
with one, and not a municipality. If you are partnering, you must attach a letter of
support from the partner not for profit/charity and supply their registration number.
Project or organization cannot already be supported by the County of Dufferin.
Funding requests are limited to one application per organization.
Projects must benefit Dufferin County residents.
No attachments will be accepted other than those requested. Additional attachments will
not be reviewed. Requested documents include:
Financial statements
Letter from partner registered not for profit/charity, if applicable
Report for previous DC Community Grant project, if applicable
The project must address one of the following County priority categories:
(you may indicate a primary and secondary, but no more than two)
Diversity, Equity and Inclusion Initiatives
Climate Action
Cultural Enhancement
Economic Development
Youth and Seniors Services
Corporate Services (Clerk’s office)
30 Centre Street, Orangeville ON L9W 2X1
Phone: (519) 941-2816
Fax: (519) 941-4565
Web Site:
County of Dufferin Application for Grant Funding Page 2
Other considerations for organizations:
1. Project proposals must clearly indicate how the initiative will benefit the participants and/or the
2. This is a competitive process. Overall funding allocation may be decreased and funding requested
by organizations may be granted in full, in part or declined, at the discretion of the assessment
3. These grants are intended to support one-time funding opportunities/projects, not ongoing
sustainability funding. Priority will be given to:
New projects (i.e. not to sustain an existing program as is)
New features or new beneficiaries of existing programs
Events that are not fundraisers (i.e. sponsorship)
4. The organization must be sustainable and able to operate without this grant funding. Financial
Statements must be attached for the application to be accepted.
5. Grant applications are assessed by a committee created and managed by Headwaters
Communities In Action. The committee has multi-sectoral representation, a solid knowledge of
Dufferin County, an analytic skill set and a collaborative approach.
Eligible Expenses:
• Purchase of goods and services in keeping with the aim of the project
• Advertising and Marketing
Ineligible Expenses:
• Overhead or administrative costs not related to the project.
• Capital funding and infrastructure costs (i.e. that which depreciates, such as office furniture,
fixtures, etc.).
Successful Grant RecipientsReporting Requirements
After project completion, or by November 30, 2021, you will be asked to publish or submit a report
sharing your story of how the Dufferin County Community Grant benefitted the community, with a
photo and a minimum of 250 words outlining the program, impacts of the project and grant, quotes
from beneficiaries and coordinators of the program, and contact information.
See a sample here.
Organizations may also be subject to a project review, and required to submit invoices and proof of
payment for goods and services. Please keep these records on hand.
A red asterisk (*) indicates a mandatory filed that must be completed.
County of Dufferin Application for Grant Funding Page 3
Organization Name:
Mailing Address:
*Primary Contact Details:
Contact Name:
*Is your organization registered as a non-profit or charitable organization? YES NO
*If YES, enter your not for profit/charitable registration number:
If NO, indicate your partner organization and their registration number, and be sure to attach their
letter of support noted in Step 11 Attachments.
Partner not for profit/charitable registration number:
Partner organization name (if applicable):
County of Dufferin Application for Grant Funding Page 4
1. Outline the mission of your organization. (max 200 words) *
County of Dufferin Application for Grant Funding Page 5
2. Outline the purpose and objectives of your project. (max 500 words) *
County of Dufferin Application for Grant Funding Page 6
3.Which one (max two) of the Dufferin County strategic priorities does this project address? Please briefly
explain how. (max 250 words) * You must select at least one, maximum two. Indicate a primary and secondary.
(Choose One)
(Choose One)
County of Dufferin Application for Grant Funding Page 7
4. How will the Dufferin community benefit from this project? Do not attach documents as a
response. (max 500 words) *
County of Dufferin Application for Grant Funding Page 8
5. What would be the direct impact of this funding on the project? * (E.g. number of people served,
greater capacity, etc.) (max 500 words)
County of Dufferin Application for Grant Funding Page 9
6. Provide details of any additional fund-raising activities planned to support this project. *
(max 250 words)
County of Dufferin Application for Grant Funding Page 10
7. Provide a plan for the implementation of this project, including key milestones, activities and
timing. * (max 10 lines)
Key Milestone
County of Dufferin Application for Grant Funding Page 11
8. If there are any other comments that you would like to include that may assist Council when
considering this application, please provide details here. (max 500 words)
County of Dufferin Application for Grant Funding Page 12
9. If your project is already underway, please provide a brief summary of accomplishments to date. If
not, please share a brief summary of accomplishments of your organization. * (max 250 words)
County of Dufferin Application for Grant Funding Page 13
10. Did you receive a Dufferin County Community Grant last year? *
Yes No
If yes, please provide an impact statement outlining how funds were spent and the impact on the
community. (max 500 words) Please note this statement may be shared publicly. If you have
issued a press release and/or any photos from the project, please attach.
County of Dufferin Application for Grant Funding Page 14
11. Attachments:
1. Most recent year-end Financial Statement (Balance Sheet and Income Statement) of the
applicant organization (if not for profit/charity) or partner organization.
2. A letter of support is mandatory if partnered with an organization for the purpose of this
3. Previous year grant impact statement press release or photos, if applicable.
County of Dufferin Application for Grant Funding Page 15
Expected Costs Description $ Amount
Expected Funding Sources $ Amount Confirmed? Requested?
County of Dufferin Application for Grant Funding Page 16
In-Kind Contributions (donation of space, materials, etc.)
Estimated $
Donor Confirmed? Requested?
Public event meeting space,
office materials, staff
Estimated Volunteer Support *
#of volunteers expected to be involved in this project: ______
Total hours of volunteer time expected to be contributed: ____
Please note the Submit Form button functions best in the Internet Explorer browser.
The personal information on this form is collected under the authority of the Municipal Act and will be
used to determine your eligibility for the community grant program. Headwaters Communities in
Action (HCIA) administers the community grant program in partnership with Dufferin County and
information collected on this form will be shared with them. Questions about this collection should be
directed to the Deputy Clerk at 519-941-2816 x 2505, 30 Centre Street, Orangeville.
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