Masterton District Council - COVID-19 Sports Grant Fund Application Form
Organisation Details
Name of organisation
*
Type of organisation
*
Please Select
Limited Liability Company
Incorporated Society
Charitable Trust
Other
Incorporated Society Number (if relevant)
Website address/social media handle
*
Physical Address
*
Street Address
Street Address Line 2
City
Region
Postal Code
Postal Address (if different)
Street Address
Street Address Line 2
City
Region
Postal Code
Contact Person
*
Role
*
e.g. Chair, Treasurer, Secretary
Phone number
*
Mobile/Landline
Email
*
example@example.com
Are you GST registered?
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Yes
No
GST Number
Bank account name
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Bank account number
*
What is the purpose of your organisation? What do you do?
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Total number of members in your organisation
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How many full-time equivalent people work in your organisation
*
How many volunteers work in your organisation
*
Upload your Strategic or Annual Plan or other documents that may assist us to understand your organisation
*
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of
Initiative, project or programme of work overview
Start date
*
-
Month
-
Day
Year
End date
*
-
Month
-
Day
Year
Who will you be working with to deliver this initiative? Include the organisations’ names
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Who will benefit from this funding?
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What outcomes are you looking to achieve through this work
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Based on the outcomes described above, how will you know you have achieved them (i.e. what will you measure and how?)
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Any additional details you would like to tell us
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Financials
Total cost of project/programme of work
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Your organisation’s contribution
*
Applications made to government or other funds
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Other outside funding confirmed
*
Describe any other income
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Amount applied for in this application
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How will the funds applied for in this application be used
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If there is any shortfall in the funding, how do you intend to fund the outstanding amount
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Have you applied to MDC for funding before
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Yes
No
If yes, when, for what purpose and how much was granted
*
Upload a basic budget overview
*
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of
Declarations
*
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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I confirm that information in this application is correct, and that any amount we receive as a result of this application will be used solely for the purposes specified in this application
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I acknowledge that MDChas the right to audit the information provided in this application and the useof any funds granted. I will provide full cooperation in the event of such anaudit being undertaken
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I confirm any unspent funds will be returned to MDC
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I confirm all expenditure will be accounted for in the Grant Accountability Form
Verification
*
Submit
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