Mouri Ora Fund Application Form

Mouri Ora Fund Application Form
- We collect personal information from you, including information about your:
  - name
  - contact information
  We collect your personal information in order to:
  - communicate with you about the Mouri Ora fund
  Providing some information is optional. If you choose not to enter contact information, the business or individual will not be recommended for funding.
  
  We keep your information safe by storing it in a secure location and limiting access to it.
  
  You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong. If you’d like to ask for a copy of your information, or to have it corrected, please contact us at funding@huttcity.govt.nz, 30 Laings Road Lower Hutt 5010.
  
  We use Jotform to collect your application. Your submission will be stored in Jotform in accordance with the Jotform Privacy Policy for 12 months before being automatically deleted.
- 1. General
- Name of contact person
  
  First NameLast Name
- Organisation name
- Organisation Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Charities or Incorporated Societies number (if applicable)
- Phone Number
  
  Area CodePhone Number
- Email
  example@example.com
- Project name
- What is the aim of your project?
  (One sentence description of the project)
- 2. Equity
- Who will the project benefit?
  (e.g. cancer survivors, Pacifica youth, elderly living alone, homeless)
- How will this project benefit them? Or what is the outcome(s) the project is trying to achieve?
  (e.g. increase employment opportunities, reduce isolation, improve mental health)
- 3. Community Led
- How have you built local participation and owership into this project?
- How will you know if the project meets the needs of community? What does success look like?
- Can you tell us a bit about any local collaborations or partnerships you have with other organisations?
- 4. Environmental Impact
- As a city, Te Awa Kairangi ki Tai / Lower Hutt has a goal of halving emissions by 2030, and reducing emissions to net zero by no later than 2050. How do aspects of your project support the Lower Hutt Climate Change Pathway?
- (This is not part of the scoring criteria for this fund)
- 5. Financial
- What is the total cost of your project?
- How much are you applying for through the Mouri Ora Fund?
- How critical is Mouri Ora Funding to your project?
- Briefly, what other sources of funding do you utilize for your kaupapa?
- Applying for multiple years of funding?
- Year 1 Amount:
- Year 2 Amount:
- Year 3 Amount:
- 6. Required Supporting Documents
  
  Before you submit your application ensure that you have attached the following supporting documents:
- Project budget for next 12 (or 24 months if applying for two years of funding):
  
  A budget for the project you are requesting funding so the panel can see how and where the funding would be spent and how this fits in with the total project budget if only part of the costs are being requested
  
  Organisational budget for next 12 (or 24 months if applying for two years of funding):
  
  To show how the project being funded fits into the bigger picture of what the organisation does / plans to do.
  
  Annual Report if produced otherwise most recent set of financial accounts:
  
  So the panel can undertake due diligence and ensure there is a reasonable financial track record
- File Upload
  
  Cancelof
- 7. HCC Privacy Declaration
  
  • Personal information provided to the Hutt City Council ('the Council'), may be held, used and disclosed by the Council to enable the Council to communicate with you for Council purposes. • I understand and agree that as this is a public fund, if this application is successful the contact details provided will Type a questionbe made public.
- Should be Empty:

Mouri Ora Fund Application Form

1. General

2. Equity

3. Community Led

4. Environmental Impact

5. Financial

Applying for multiple years of funding?

6. Required Supporting Documents

7. HCC Privacy Declaration