Fillable Form 1: (Queenstown Lakes District Council New Zealand)

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Form 1: (Queenstown Lakes District Council New Zealand)

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1
Creative Communities
Scheme (CCS)
Application Form
Funding for local arts
Ngā kaupapa auaha a te iwi whānui
Te tono pūtea mō ngā manahau a te iwi kāinga
Read the Creative Communities Scheme (CCS) Application Guide
This guide tells you –
> if you are able to apply for a CCS Grant for your project
> what information you will need to include in your application
> how to submit your application.
You can print this document out and handwrite your application or you may like to save
a copy of this application to your desktop and enter the information this way. If you
need more space attach information to the back of this application form. Please include
the section number and heading for easy assessing.
Creative Communities Scheme: Application form 2
Contact the CCS administrator if you need advice on your application.
Jan Maxwell
Arts and Events Facilitator
Queenstown Lakes District Council
PH 03441 0469
027 2337934 Email: jan.maxwell@qldc.govt.nz
Applicant details
Are you applying as an individual or group?
Individual
Group
Full name of applicant
Contact person (for a group)
Daytime phone number
Postal address
All correspondence will be sent to this address.
Street/PO Box
Suburb
Postcode
City
Email
Ethnicity of applicant
Please tick and provide detail e.g. Ethnicity: Pacific Island, Detail: Samoan.
Ethnicity Detail
NZ European
Māori
Pacific Island
Middle Eastern/Latin American/African
Other
Creative Communities Scheme: Application form 3
Bank account name and number
This is where funds will be deposited if your application is successful.
Name
Account number
1 Project details
Project name
For example, South Taranaki
children’s ceramic workshops.
Brief description
For example, six ceramic workshops during the scho
ol holidays for children aged 8–12.
Does your project have an arts or creative cultural focus?
Yes
No
Will your project take place within the city or district where the
application is made?
Yes
No
If the answer is no to either of these questions your project is likely to be ineligible.
Please contact your CCS administrator.
Creative Communities Scheme: Application form 4
Funding criteria
Which of the scheme’s three funding criteria are you applying under.
Please select one. If your project meets more than one criteria, choose the one
that is the project’s main focus.
You can find examples of each criteria in the CCS Application Guide page 10
Participation
: Create opportunities for local communities to engage with, and
participate in local arts activities.
Diversity
: Support the diverse arts and creative cultural traditions of
local communities.
Young people
: Enable young people (under 18 years) to engage with, and
participate in the arts.
If you do not know which of the three fits your project, contact your CCS administrator.
2 The idea/He aha te kaupapa
See the CCS Application Guide on page 2
What do you want to do?
Creative Communities Scheme: Application form 5
3 The benefit/He aha ngā hua
See CCS Application Guide page 3
How will your project benefit your community?
4 The process/Pehea te whakatutuki
See CCS Application Guide page 3
Where, when and how will the project happen?
Venue/location:
Project start and finish dates:
Details of how the project will happen:
Creative Communities Scheme: Application form 6
5 The people/Ko wai ngā tāngata
See CCS Application Guide page 5
Tell us about the key people and/or community involved
Estimated number of active participants
Estimated number of attendees
6 The budget/He pūtea
How much will it cost?
Are you GST registered?
Yes
No
GST number
|
|
If you are GST registered, do not include GST in these amounts.
If you are not GST registered, please provide the amounts including GST.
This budget includes GST This budget does not include GST
Creative Communities Scheme: Application form 7
Project costs
Write down all the costs of your project and include the details.
For example materials, venue hire, promotion, equipment hire, artist fees
and personnel costs.
See CCS Application Guide page 6
Item
Detail
Amount
e.g. Hall hire
e.g. 3 days hire at $100.00 per day
e.g. $300.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
A: Total cost
$
0
Creative Communities Scheme: Application form 8
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.
Item
Detail
Amount
e.g. Ticket sales
e.g. 250 tickets at $15.00 per ticket
e.g. $3,750.00
$
$
$
$
$
$
$
$
$
$
B: Total income
$
Calculate your requests from CCS using this table.
A:
Total cost of project
$
B:
Less total income
$
C:
Difference
$
D:
Amount requested from CCS
$
0
0
0
0
Creative Communities Scheme: Application form 9
Financial background
Tell us about any other funding you have applied for or received for this project
(including funds from Creative New Zealand’s other funding programmes).
Date
applied
Source of funding Type of
funding
e.g. grant
Date of
result
Amount
$
$
$
$
$
Tell us about other grants you have received through CCS in the past
three years.
Date Project title Have you submitted a
project completion report
for this project?
Amount
$
$
$
$
$
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 10
7 Artform, activity and cultural tradition
Which of the following artforms best describes your project?
Please select one. If your project combines more than one artform select
combined arts.
See CCS Application Guide page 6 for definitions of each artform
Combined arts Māori arts
Craft/Object art Music
Dance Pacific arts
Film Theatre
Literature Visual arts
Which of the following activities best describes your project?
Please select one.
See CCS Application Guide page 8 for definitions
Creation only
Creation and presentation
Presentation only (performance or concert)
Presentation only (exhibition)
Workshop
Creative Communities Scheme: Application form 11
What is the cultural tradition of your project?
The cultural tradition of your project relates to the particular heritage that your project is
part of. Cultural tradition does not relate to your group’s ethnic affiliations or
geographical origins.
Select the cultural tradition that best relates to your project and give additional
information if needed.
For example, a kapa haka performance would be categorised as Māori arts or a traditional
Polish dancing workshop would be Cultural tradition: European, Detail: Polish.
Cultural tradition Detail
European
Māori arts
Pacific arts
Middle Eastern/Latin American/African
Other
8 Declaration
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
> 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
Creative Communities Scheme: Application form 12
> participate in any funding audit of my organisation or project conducted by the local
council if required
> 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 (e.g. poster, flyers, e-newsletters) for the project
and follow the guidelines for use of the logo. Logo and guidelines can be
downloaded from www.creativenz.govt.nz/logo.
I understand that the Queenstown Lakes District Council
> is bound by the Local Government Official Information and Meetings Act 1987
> I/we also consent to it 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
Signature
Name and signature of parent or guardian if applicant is under 16 years of age:
Name
Signature
Position in organisation if applicable
Date
Creative Communities Scheme: Application form 13
How did you hear about this fund?
Council website Radio
Council mail out Social media
Council staff member Word of mouth
Creative New Zealand website Other (please give detail):
Local Newspaper
Poster/flyer
9 Final check
Make sure you have
Completed all the sections
Checked that your budget balances
Provided quotes and financial details
Attached supporting documents
Submitting your application
Mail your application to:
Queenstown Lakes District Council
Private Bag 50072
Queenstown 9300
Courier or hand deliver your application to:
Queenstown Lakes District Council
10 Gorge Road, Queenstown
Or 47 Ardmore Street, Wanaka
E
mail your application to:
jan.maxwell@qldc.govt.nz
Click here to SUBMIT by email
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Form 1: (Queenstown Lakes District Council New Zealand)

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Completed 11 February 2021

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