Fillable Sport New Zealand Background Rural Travel Fund Application (Waitomo District Council New Zealand)

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Sport New Zealand Background Rural Travel Fund Application (Waitomo District Council New Zealand)

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Country of origin: NEW-ZEALAND
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Queen Street, P O Box 404, Te Kuiti 3941, NZ. Telephone 07-878 0800, Fax 07-878 7771, Email enquiries@waitomo.govt.nz, Website www.waitomo.govt.nz
Sport New Zealand
Rural Travel Fund Application
Background
The Rural Travel Fund was developed in response to concerns raised by territorial
authorities about the lack of participation in sport by young people living in rural
communities. Geographical isolation, urban drift, lack of employment opportunities
and access to mainstream funding were identied as barriers to sport participation.
The Rural Travel Fund is designed to help subsidise travel for junior teams
participating in local sporting competitions. The allocation of the fund is based on a
population density formula for territorial authorities whom have less than 10 people
per square kilometre based on 20c per capita (Source : Census Statistics 2001).
Rural Travel Fund Eligibility
Application for the Rural Travel Fund is open to rural sports clubs and rural school
teams with young people aged between 5 and 19 years who require subsidies to
assist with transport expenses to local sporting competitions.
The Rural Travel Fund is managed by the territorial authority and funding should not
be provided for the purpose of travel to regional or national events.
Assessment Criteria
The following criteria shall be applied when considering applications for funding:
School club teams and sport club teams are dened as:
• a school club team participating in local sport competition in weekends, that
excludes inter-school and intra-school competitions played during school time
and/or
• a sports club team participating in organised sport competition through club
membership outside of school time.
1. Organisation Contact Details
Full Name
Postal Address
Phone
Mobile
Fax
Contact Numbers
Physical Location
Email
Contact Persons
Please list two contact names
Name
Position
Phone(day)
Email
Name
Position
Phone(day)
Email
Are you a club or school?
How many members belong to your club/organisation?
Will the travel subsidy benet participants aged between 5 and 19?
Yes
No
If yes, how many participants?
How many participants are aged between 5 and 12 years?
How many participants are aged between 13 and 19 years?
What is the total number of male participants?
What is the total number of female participants?
Does your application involve a partnership with a local school?
Yes
No
Briey describe what is the funding used for?
2. Organisation Details
Sport New Zealand
Rural Travel Fund Application
247124v2 : CDF10 : 1/3
What percentage of your members live in the vicinity of the local authority you are applying to, for the
Rural Travel Fund?
3. Financial Details
Are you GST registered?
Yes
No
If yes, please provide your GST Number
How much money are you applying for?
Sport NZ Funding
Other Funding
Your Contribution
TOTAL
Have you applied to any other organisation for funding?
Yes
No
If yes, what please detail below
Organisation (including
other Councils)
$ Amount
Results Date
(if known)
Do you have endorsement of your local afliated club/school for this
application for funding?(This is only relevant if the group applying is the
regional body)
Yes
No
Briey explain and attach evidence of this
4. Travel Information
Total distance travelled (km)
Total number of trips
Total number of vehicles used
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In making this funding application:
1. We hereby declare that the information supplied here on behalf of our organisation is
correct.
2. We agree to provide an accountability report to the Waitomo District Council.
3. We consent to Waitomo District Council collecting the personal contact details and information
provided in this application, retaining and using these details and disclosing them to Sport NZ for the
purpose of review of the Rural Travel Fund. This consent is given in accordance with the Privacy Act
1993.
Name
Name
Signature
Signature
Position
Position
Date
Date
5. Declaration and Consent
6. Checklist
Please read and complete the following before submitting your application. Incomplete or late
applications will not be accepted.
Applicant Use
Ofce
Use
Completed ALL sections of the application?
Checked all gures within the application?
Attached a copy of your organisation’s balance sheet/nancial statement?
Evidence of your endorsement from your local afliated club/school (if required)
Attached a bank deposit slip (If your application is approved, payment will be
direct credited into your nominated account)
Have you:
Please send completed applications to:
Waitomo District Council
PO Box 404
Te Kuiti 3941
Ph: 07 878 0800
Fax: 07 878 7771
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Sport New Zealand Background Rural Travel Fund Application (Waitomo District Council New Zealand)

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Completed 8 November 2020

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