Disability Inclusion Fund 2021-24

Applicant Information

SECTION 2
Q8. Organisation name*
Q9. Organisation address*

Street Address Line 1

Street Address Line 2

Suburb / TownCity / Province

Post Code
Q10. What is the legal status of your organisation?*

Charitable TrustIncorporated SocietyRegistered CharityOther
Q11. What is your organisation's Incorporated Society Number or New Zealand Business Number (NZBN)?
We will confirm this at https://www.nzbn.govt.nz/
Q12. Is your organisation registered for GST?*

YesNo
Q13. What is your organisation's GST number?
Type numbers only 000-000-000
Q14. Primary contact name*

First NameLast Name
Q15. Primary contact role*
Q16. Primary contact email*
example@example.com
Q17. Primary contact phone*

Area or Cell CodeLandline or Cell Number

Request for Investment

SECTION 3
Q18. Please state the period for which you are requesting investment?*

One year 2021/22One year 2022/23Two years 2021/22 and 2022/23Two years 2022/23 and 2023/24Three years 2021/22 to 2023/24
Q19. What is the total amount of investment (GST exclusive) which you are requesting? *
Type numbers only

Proposal Overview

SECTION 4
Q20. Initiative name*
Q21. Initiative manager's name*

First NameLast Name
Q22. Proposed start-date*

DayMonthYear
Q23. Proposed end-date*

DayMonthYear
Q24. Budgeted total cost (GST exclusive)*
Amount to be funded from all sources of income including amount requested from Sport NZ at Q19
Q25. Proposed location/s - please detail where your activities will take place*
Please separate location names with a comma ","
Q26. Proposed initiative/s - please detail what you will do*

Proposal Assessment

SECTION 5
DISABILITY LEADERSHIP
Q27. Please provide evidence of your organisation's leadership (and/or potential to lead) in the disability space.*
Refer to the Guidelines to help you answer this question
PROPOSAL IMPACT
Q28. Please identify the target audience for your proposed initiative/s. Will the initiative/s aim to impact disabled tamariki and/or rangatahi who have:*

Intellectual impairmentsInvisible impairmentsPhysical impairmentsLower levels of physical activity (than those already participating)Fewer opportunities to participate (than those already participating)Are less interested in existing opportunities (than those already participating)Are less able to access existing opportunities (than those already participating)
Q29. Please describe how your proposed initiative/s will engage with the target audience.*
Refer to the Guidelines to help you answer this question
PROPOSAL LEGACY
Q30. Please provide detail of how the proposed initiative/s will create sustainable change within your organisation’s networks and/or across the play, active recreation and sport sector.*
Refer to the Guidelines to help you answer this question
PROPOSAL ALIGNMENT
Q31. Please provide detail of how the proposed initiative/s will align with Sport NZ’s strategy. *
Refer to the Guidelines to help you answer this question
SUPPORTING INFORMATION
Q32. If relevant, please attach files to support your answers to Section 5.

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Proposal Delivery

SECTION 6
CAPACITY AND CAPABILITY
Q33. Please provide evidence of your organisation's experience, capacity and capability to deliver the proposed initiative/s.*
Refer to the Guidelines to help you answer this question
INITIATIVE PLAN
Q34. Please upload your initiative plan (in PDF format)*

Refer to the Guidelines to help you answer this question
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INITIATIVE BUDGET
Q35. Please upload your initiative budget (in Excel format)*

Refer to the Guidelines to help you answer this question
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Payment Information

SECTION 7
Q36. Bank account number*
Type numbers only 00-0000-0000000-000
Q37. Bank account name*
Q38. Please attach a copy of your most recent bank statement, with the bank account name and number clearly visible*

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Application Form Contents