Community Resilience Fund Phase 2
APPLICATION FORM
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Eligibility
If your organisation's main purpose (Q1), or your organisation type (Q3) is not in the drop down boxes, then you are not eligible for the Community Resilience Fund Phase 2.
Q1. What is your organisation's main purpose?
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Play
Active Recreation
Sport
Sports Hub
Q2. Please describe how your organisation gets people physically active through play, active recreation or sport
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0/250
Q3. What type of organisation are you? If you are more than one, just select one.
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Incorporated Society
Charitable Trust
Registered Charity
Q4. What is your Incorporated Society Number or New Zealand Business Number (NZBN)? We will look these up on https://www.nzbn.govt.nz/
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Applicant Details
Q5. Name of person applying
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First Name
Last Name
Organisation Name
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Role in the Organisation
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Email
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example@example.com
Phone Number
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-
Area Code
Phone Number
Q6. I authorise my contact details to be added to Sport NZ's and the RST's contact lists. (Your answer will have no impact on the assessment of your application.)
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Yes add me to Sport NZ's contact list
Yes add me to my Regional Sports Trusts contact list
No I don't want to be added to any contact list
Q7. If you're affiliated to a Sport NZ partner please select the organisation from the list. If you are not affiliated to a Sport NZ partner, or you're a Sports Hub, please select Other.
Archery New Zealand Inc
Athletics New Zealand
Badminton NZ
Baseball NZ
Basketball New Zealand
Bowls New Zealand
Boxing New Zealand Inc
Canoe Slalom
Canoe Racing
Croquet New Zealand
Cycling NZ
Diving New Zealand
Duke of Edinburgh
Equestrian Sports New Zealand
Flying New Zealand
GirlGuiding NZ
Gliding New Zealand
Gymnastics New Zealand
Halberg Disability Sports Foundation
Hockey NZ
Ice Speed Skating New Zealand
International Taekwon-Do Foundation (ITFNZ)
Karate New Zealand
Kart Sport New Zealand
Marching New Zealand
Motorcycling NZ
Motorsport NZ
Mountain Safety Council
Netball NZ
New Zealand Confederation of Billiard Sports Inc
New Zealand Football
New Zealand Ice Figure Skating Association
New Zealand Petanque Association
New Zealand Polocrosse Inc
New Zealand Powerlifting Federation
New Zealand Rugby League
New Zealand Secondary Schools Sports Council
New Zealand Shooting Federation
New Zealand Water Polo Association
NZ Alpine Club
NZ Australian Football League
NZ Cricket
NZ Curling Association
NZ Darts Council
NZ Golf
NZ Ice Hockey Federation
NZ Indoor Bowls
NZ Judo Federation
NZ Orienteering Federation
NZ Pony Clubs Association
NZ Power Boat Federation
NZ Rugby
NZ Water Ski Association
NZ Outdoor Instructors Association
Olympic Weightlifting New Zealand
Paralympics New Zealand
Physical Education New Zealand
Recreation Aotearoa
Rowing New Zealand
Scouts NZ
Skate NZ
Snow Sports NZ
Softball New Zealand
Special Olympics New Zealand
Speedway New Zealand
Squash New Zealand
Surf Life Saving New Zealand
Surfing New Zealand
Swimming New Zealand
Synchro Swim New Zealand
Table Tennis New Zealand
Tennis NZ
Touch New Zealand
Triathlon New Zealand
Volleyball New Zealand
Waka Ama New Zealand
World Taekwondo New Zealand
Wrestling New Zealand
Yachting NZ
YMCA
Other
Q8. How many annual members or participants does your organisation have?
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Q9. Are your members or participants individual people or organisations?
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Individuals
Organisations
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Organisation’s GST and Bank Account Details
Q10. Is your organisation registered for GST?
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Yes
No
Q11. What is your organisations GST Number?
Q12. What is your organisations bank account name?
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Q13. What is your organisations bank account number?
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Q14. Please attach a photo or screenshot of your latest bank statement, with the bank account name and number clearly shown.
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Q15. Are you applying for more than $5,000?
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Yes
No
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Application for funds
Q16. What was your total income for your last financial year? ($)
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Q17. What were your total expenses for your last financial year? ($)
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Q18. What were your salary or wage costs for your last financial year?
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Q19. How much income ($) will your organisation lose this year as a result of Covid-19? (We know this will be an estimate. Please simply provide your best estimate, thinking about revenue lost in the 12 months from 1 April 2020.)
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Q20. Please describe the lost income and how you've calculated it.
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0/250
Q21. What changes have you made to manage the impact of Covid-19? Describe decisions, actions, when they were taken, and the result. For example, outcome if you applied for the Government wage subsidy, what costs you have already reduced, how you have already used or are planning to use available cash reserves.
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0/250
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Costs you are applying for
Q22. Costs you are applying for – list each cost and amount. E.g. “Actual Electricity bills July to August $xx”, “Pro-rated insurance bill for three months”. Note that we will cover fixed administration and operating costs for the period 1 July to 30 September 2020, affiliation fees that are payable in the period 1 April to 30 September 2020, and up to three months’ worth (pro-rated) of audit and insurance costs, only. These amounts may be from actual bills received already, or estimated costs (except affiliation fees). If your costs are pro-rated, please tick the Pro-rated? box.
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Description of Cost
Amount ($)
Pro-rated?
Cost 1
Cost 2
Cost 3
Cost 4
Cost 5
Cost 6
Cost 7
Cost 8
Cost 9
Cost 10
Cost 11
Cost 12
Cost 13
Cost 14
Cost 15
Q23. Do these costs include GST?
Yes
No
Q24. If your organisation has any reserves or savings, please tell us the $ value
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Q25. Please detail any supporting information for Q24 e.g. amounts that are already contracted, or have been set aside for specific projects, and what they are committed/intended for
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0/250
Q26. Please attach a copy of your latest audited financial statements. These must be no more than 18 months old i.e. the end date of the financial statements must not be earlier than January 2019.
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Application for funds
Q15. How much income ($) will your organisation lose this year as a result of Covid-19? (We know this will be an estimate. Please simply provide your best estimate, thinking about revenue lost in the 12 months from 1 April 2020.)
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Q16. Please describe your financial hardship as a result of Covid-19
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0/400
Q17. What changes have you made to manage the impact of Covid-19? Describe decisions, actions, when they were taken, and the result. For example, outcome if you applied for the Government wage subsidy, what costs you have already reduced, how you have already used or are planning to use available cash reserves
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0/250
Q18. Costs you are applying for – list each cost and amount. E.g. “Actual Electricity bills July to August $xx”, “Pro-rated insurance bill for three months”. Note that we will cover fixed administration and operating costs for the period 1 July to 30 September 2020, affiliation fees that are payable in the period 1 April to 30 September 2020, and up to three months’ worth (pro-rated) of audit and insurance costs, only. These amounts may be from actual bills received already, or estimated costs (except affiliation fees). If your costs are pro-rated, please tick the Pro-rated? box.
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Description of Cost
Amount ($)
Pro-rated?
Cost 1
Cost 2
Cost 3
Cost 4
Cost 5
Cost 6
Cost 7
Cost 8
Cost 9
Cost 10
Cost 11
Cost 12
Cost 13
Cost 14
Cost 15
Q19. Do these costs include GST?
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Yes
No
Q20. Please tell us the value ($) of your organisation’s reserves or savings, that have not been committed or intended for other use.
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Q21. Please attach a copy of your latest audited financial statements. These must be no more than 18 months old i.e. the end date of the financial statements must not be earlier than January 2019.
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Conditions of Application
I confirm that I am authorised to submit this application on behalf of the organisation, and that our directors and/or trustees and/or treasurer are aware of and support this submission.
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Yes
No
I confirm that information in this application is correct, and that any amount we receive as a result of this application will be used as specified in our application form.
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Yes
No
I acknowledge that Sport NZ has the right to audit the information provided in this application and the use of any funds granted. I will provide full cooperation in the event of such an audit being undertaken.
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Yes
No
I note the “Protecting your information” section of the “Sport NZ Community Resilience Fund Phase 2 Guidelines”. We authorise Sport NZ to make such enquiries as it deems fit in considering the application (including banking details) and we accept and agree that details of any grant Sport NZ makes to our organisation may be made public.
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Yes
No
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