Fillable Creative Communities Scheme Application Form (Waimakariri District Council New Zealand)

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Creative Communities Scheme Application Form (Waimakariri District Council New Zealand)

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Creative Communities Scheme
Application Form
Funding for local arts projects
Ngā pūtea mō ngā toi te hautāinga
Closing Date
For Projects that take place
between
To submit your Creative
Communities Scheme
application please complete,
print and return this form to:
Monday 29 March 2021
1 May 2021 and 1 May 2022
Karen Livingstone
Creative Communities Administrator
215 High Street, Private Bag 1005
RANGIORA 7440
Phone 03 311 8901 or 0800 965 468
Email: karen.livingstone@wmk.govt.nz
181129140492
BEFORE YOU START
Creative Communities Scheme Application Form Page 1
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 (Creative Communities
Scheme Application Form or an online version of this document)
• To complete this application form in Microsoft Word (version 2003 or newer) you
need to type your answers to each question in the boxes provided.
Example:
Type your answer here
• 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.
Please 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)
My project has an arts 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
I have read and signed the declaration
I have made a copy of this application for my records
PART 1: APPLICANT DETAILS
Creative Communities Scheme Application Form Page 2
Are you applying as an individual or group?
Individual
Group
Full name of applicant:
Contact person (for a
Street address/PO Box:
Suburb:
Town/City:
Postcode:
Country:
New Zealand
Email:
Telephone (day):
All correspondence will be sent to the above email or postal address
Name on bank account:
GST number:
Bank account number:
Ethnicity of applicant/group (mark with an X, you can select multiple options)
New Zealand European/Pākehā:
Detail:
Māori:
Detail:
Pacific Peoples:
Detail:
Asian:
Detail:
Middle Eastern/Latin American/African:
Detail
Other:
Detail:
Yes:
No:
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)
PART 2: PROJECT DETAILS
Creative Communities Scheme Application Form Page 3
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
Activity best 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
PROJECT DETAILS
Creative Communities Scheme Application Form Page 4
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.
Tell us about the key people and/or the groups
Tell us how this project will deliver to your selected
PROJECT DETAILS (budget)
Creative Communities Scheme Application Form Page 5
See the CCS Application Guide for more detail on how to complete this section.
Are you GST registered?
Yes
Do NOT include GST in your budget
No
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 Detail 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 Detail 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
$
PROJECT DETAILS (budget)
Creative Communities Scheme Application Form Page 6
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.
I
f your group or organisation has reserves which are not being used for this project you
should include your reserves statement or policy
PART 3: DECLARATION
Creative Communities Scheme Application Form Page 7
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 Waimakariri District Council is bound by the Local Government Official
Information and Meetings Act 1987
I/we consent to Waimakariri 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
NB: All applications by person/s under the age of 18 must be signed by applicant’s parent or legal
di
Name
(Print name of contact person/applicant)
Signed:
(Applicant or arts organisation’s contact person)
Date:
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Creative Communities Scheme Application Form (Waimakariri District Council New Zealand)

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Completed 20 January 2021

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