Creative Communities Application Form

Creative Communities Application Form
Funding for local arts projects Ngā pūtea mō ngā toi te hautāinga
My project has an arts focus*

Yes
My project takes place in the local authority district that I am applying to*

Yes
Are you Applying as*

IndividualGroup
Full name of applicant*
Contact person (for a group)*
Contact Details
Address*

Street Address

Street Address Line 2

City / TownProvince

Postal Code
Email*
example@example.com
All correspondence will be sent to the above email or postal address
Telephone (day)*
Name on Bank Account*
Bank account number*
If you are successful your grant will be deposited into this account

The budget/Ngā pūtea

See the CCS Application Guide for more detail on how to complete this section.
Are you GST registered?

Yes - Do NOT include GST in your budgetNo - Include GST in your budget
GST Number*
Project Costs

Write down all the costs of your project and include the details, eg materials, venue hire, promotion, equipment hire, artist fees and personnel costs.
Total Costs (A) =*
Project Income

Write down all the income you will get for your project from ticket sales, sale of artwork, other grants, donations, your own funds, other fundraising. Do not include the amount you will be requesting from CCS.
Total Income (B) =*
Total Costs less Income (A-B) =*
This is the maximum amount you can request from CCS
Amount you are requesting from the Creative Communities Scheme*

Other Financial Information
Tell us about any other funding you have applied for or received for this project (remember you can’t receive funds for your project from both CCS and Creative New Zealand’s other funding programmes).
Tell us about other grants you havereceived through the Creative Communities Scheme in the past threeyears.
Groups or organisations must provide a copy of their latest financial statement. This can be a copy of the audited accounts, an income and expenditure statement or a copy of the unaudited management accounts.*

Cancelof
If your group or organisation has reserves which are not being used for this project you should include your reserves statement or policy

Consent
I understand that the Waitomo District Council is bound by the Local Government Official Information and Meetings Act 1987*

Yes
I/we consent to Waitomo District Council recording the personal contact details provided in this application, retaining and using these details, and disclosing them to Creative New Zealand for the purpose of evaluating the Creative Communities Scheme.*

Yes
I/we understand that my/our name and brief details about the project may be released to the media or appear in publicity material.*

Yes
I/we undertake that I/we have obtained the consent of all people involved to provide these details. I/we understand that I/we have the right to have access to this information. This consent is given in accordance with the Privacy Act 1993*

Yes
Applicant Age*

18 or overUnder 18
Guardian Name*
Guardian contact phone number*
I have authorisation to submit this application form on behalf of the above mentioned applicant*

Clear
NB:All applications by person/s under the age of 18 mustbe signed by applicant’s parent or legal guardian.
Should be Empty:

Funding for local arts projects Ngā pūtea mō ngā toi te hautāinga