Fillable Funding-Application-Form Community Funding Application Form - Interactive Form

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Funding-Application-Form Community Funding Application Form - Interactive Form

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GRLOAN-706567245-376 December 2018 1
Community Funding Application Form
If you need help to complete this application form or would like to discuss your application, please
contact the Community Funding Officer well before the closing date of the round you are applying
to. Call 09 430 4200 or email funding@wdc.govt.nz
to make an appointment.
Funding information and closing dates are at www.wdc.govt.nz/funding.
Summary information
Organisation name
Amount requested
$
Project name
Which Fund you are
applying to? Choose only
one (tick or highlight).
Check the Funding Guide
for criteria and closing
dates.
☐ Community Fund
☐ Performing Arts Fund
☐ Community Halls Maintenance Fund
☐ Resident and Ratepayer Fund
☐ Partnership Fund
(additional documentation required – refer to Guide)
☐ Community Loan
(additional documentation required – refer to Guide)
☐ Other, please specify:
Section 1: Your Details
Tell us about your organisation/group
Group’s postal address
If we have questions about this application, who should we talk to? Please provide 2 contacts and
ensure you have the authority of the group you are applying on behalf of.
* Note: We will use this email to ask questions and advise you of the outcome of this application.
Primary contact’s name
Position in group
Email *
Daytime phone number(s)
Second contact’s name
Position in group
Email
Daytime phone number(s)
GRLOAN-706567245-376 December 2018 2
Section 2: Eligibility
Is your group a not-for-profit legal entity?
Yes – please provide:
• Your incorporated society or charitable trust registration number: _____________________
(please make sure your register is up to date to be eligible).
No
* – you will need to:
• EITHER gain legal status (see http://www.societies.govt.nz/cms/customer-support/faqs
),
• OR apply under the umbrella of a group that does meet this requirement (refer below).
Note: Community Loan applicants must be a not-for-profit legal entity and cannot use an
umbrella group.
*Umbrella Group Guarantee
Applicants that are not a registered charitable trust or incorporated society must apply under an
umbrella group that is.
A suitable umbrella group knows the applicant well and is willing to vouch for them and their project,
and are prepared to accept legal liability and responsibility.
Grants are paid to the umbrella group for disbursement to the applicant in accordance with the
grant agreement.
If the grant conditions are not met, Council may request the grant monies to be returned and/or may
place restrictions on granting funds to the applicant and the umbrella organisation in future.
The following section is to be completed by an authorised officer of the umbrella group.
Umbrella group name
Society or trust number:
Contact person
Email
Daytime phone number(s)
I confirm that our organisation is willing to guarantee and receive any monies granted to:
Applicant organisation: ........................................................................................................................
Project name: …..................................................................................................................................
Signature
Date
Please provide a bank deposit slip or other evidence of umbrella group’s bank account details.
GRLOAN-706567245-376 December 2018 3
Section 3: The Project
Tell us what you want to do – Who, What, When, Where, Why, How
Describe your project in terms of the following:
Name of project
Amount requested $
When and where will this
take place?
Who will likely benefit from
your project?
How many people will
directly benefit?
Ethnicities of likely beneficiaries of this project – tick as appropriate and include a percentage estimate for each
that you think will benefit from this project:
NZ European – estimate %:
Maori – estimate %:
Pacific Peoples – estimate %:
Other European - estimate %:
Asian - estimate %:
Middle Eastern/Latin American/African – estimate %:
Other ethnicity – estimate %:
Area of work
To help us understand where support is being requested, please select which of the following relate
most closely to your project.
Arts and Culture – Projects and activities that facilitate education and enjoyment of the arts
and of culture for the people of our District.
Heritage and Environment – Projects and activities that preserve and promote the heritage
of our District and that protect and enhance the environment in which we live.
Recreation and Sport – Projects and activities that enable participation and engagement in
recreation and sport for people in our district of all abilities, ages and life stages.
Community Connectedness and Wellbeing – Projects and activities that strengthen
community cohesion and connectedness in ways that cultivate healthy, happy and
positive relationships across our District.
GRLOAN-706567245-376 December 2018 4
Tell us about your request in the following questions. Be succinct and clear.
The Idea – Briefly explain what it is that you want to do:
The Need –
What need is there for your project, programme or service?
GRLOAN-706567245-376 December 2018 5
The Impact –
What difference will your project make?
Your Readiness – What controls and checks do you have in place to manage the funding?
GRLOAN-706567245-376 December 2018 6
Your Readiness – Tell us about your team’s structure and how you will manage the funding to
achieve the outcome.
Collaboration – Who will you work with to deliver your project, programme or service?
GRLOAN-706567245-376 December 2018 7
Your Approach –
How do you demonstrate value for money and the impact of your work?
Your Approach – How does your project, programme or service meet best practice and is it
evidence based?
GRLOAN-706567245-376 December 2018 8
Section 4: Project Budget
Provide a full list of your project income, fundraising and expenses. If your budget is detailed,
provide a summary below and attach your budget separately.
Are you registered for GST? No – include GST where applicable
Yes – exclude GST from your budget
GST number
(A) Project income/contributions
Amount
Other grants and donations $
Own contribution / fundraising $
Other income (e.g. ticket sales) $
$
$
$
(A) Total income expected
$
In-kind support – please list
e.g. volunteer numbers, estimated hours of work, plus any donated materials,
equipment etc.
Volunteer Numbers: Estimated Hours Work:
(B) Total project costs
Include all your project costs. e.g. materials, venue hire, promotion,
equipment hire, personnel costs. For items over $500, please attach quotes.
$
$
$
$
$
$
$
(B) Total expenses expected
$
(C) Income less expenses
$
GRLOAN-706567245-376 December 2018 9
Declaration
On submitting this application for funding, you have deemed acceptance of these terms
and conditions.
I declare that I have the consent of the group/organisation to make this application and provide
these details.
I declare that the information supplied here is correct.
If the application is successful, I/we agree to:
• provide a tax invoice to Whangarei District Council for the amount of the grant within two
months of being advised. I understand that grant payments will only be made to a bank
account in the name of the applicant group or the umbrella group as appropriate.
• acknowledge Whangarei District Council in all publicity
• spend the grant on the purpose for which the application was made within 12 months of
funding being approved
• return any unspent money to Whangarei District Council if the event is completed under
budget
• meet any additional terms and conditions that may be set by Whangarei District Council
• acknowledge that we will be liable to return any monies granted should any breach of the
above conditions occur
• submit a Funding Report within two months of the completion of the project to Whangarei
District Council (or as otherwise requested)
• keep all invoices and receipts accounting for the full amount of the grant or loan, and provide
these if requested.
I/we consent to the Whangarei District Council recording the personal contact details provided in
this application, and using this to send me community funding related information. I understand I
can opt out anytime.
I/we understand that my name and/or the name of my group/organisation and brief details about
the project/event may be released to the media or appear in publicity material.
I/we understand that we have the right to have access to this information held by Council. This
consent is given under the Privacy Act 1993.
Submitting your application
Send your application and any supporting material to funding@wdc.govt.nz. You can also drop it in
to us at Forum North or Walton Plaza, or post it to us at:
Attention: Community Funding
Whangarei District Council
Private Bag 9023
Whangarei 0148
We will acknowledge receipt of your application by email. If you don’t hear from us within 7 days,
please call 09 430-4200 to check we have received it.
Most funding decisions are advised 6 weeks after the funding round closes.
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Funding-Application-Form Community Funding Application Form - Interactive Form

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Completed 3 May 2020

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