Sport New Zealand Rural Travel Fund Application

Sport New Zealand Rural Travel Fund Application
Background
The Rural Travel Fund was developed in response to concerns raised by territorial
authorities about the lack of participation in sport by young people living in rural
communities. Geographical isolation, urban drift, lack of employment opportunities
and access to mainstream funding were identified as barriers to sport participation.

The Rural Travel Fund is designed to help subsidise travel for junior teams
participating in local sporting competitions. The allocation of the fund is based on a
population density formula for territorial authorities whom have less than 10 people
per square kilometre based on 20c per capita (Source : Census Statistics 2001).
Rural Travel Fund Eligibility
Application for the Rural Travel Fund is open to rural sports clubs and rural school
teams with young people aged between 5 and 19 years who require subsidies to
assist with transport expenses to local sporting competitions.

The Rural Travel Fund is managed by the territorial authority and funding should not
be provided for the purpose of travel to regional or national events.
Assessment Criteria
The following criteria shall be applied when considering applications for funding:

School club teams and sport club teams are defined as:
- a school club team participating in local sport competition in weekends, that
  excludes inter-school and intra-school competitions played during school time
and/or
- a sports club team participating in organised sport competition through club
  membership outside of school time.

Organisation Contact Details
Name*
Postal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physical Location*
Phone*
Mobile*
Email*
example@example.com

Contact Persons

Please list two contact names
First Person
Name*
Position*
Phone (day)*
Email*
example@example.com
Second Person
Name*
Position*
Phone (day)*
Email*
example@example.com

Organisation Details
Are you a*

ClubSchool
How many members belong to your club/organisation?*
Will the travel subsidy benefit participants aged between 5 and 19?*

YesNo
If yes, how many participants?*
How many participants are aged between 5 and 12 years?*
How many participants are aged between 13 and 19 years?*
What is the total number of male participants?*
What is the total number of female participants?*
Does your application involve a partnership with a local school?*

YesNo
Briefly describe what is the funding used for?*
What percentage of your members live in the vicinity of the local authority you are applying to, for the Rural Travel Fund?*

Financial Details
Are you GST registered?*

YesNo
If yes, please provide your GST Number*
How much money are you applying for?
Sport NZ Funding*
Other Funding*
Your Contribution*
TOTAL*
Have you applied to any other organisation for funding?*

YesNo
If yes, what please detail below
Do you have endorsement of your local affiliated club/school for this application for funding?(This is only relevant if the group applying is the regional body)

YesNo
Briefly explain endorsement *
Attach evidence of endorsement*

Cancelof
Travel Information
Total distance travelled (km)*
Total number of trips*
Total number of vehicles used*

Required documents
Attach a copy of your organisation’s balance sheet/financial statement*

Cancelof
Attached a Bank Deposit Slip*

If your application is approved, payment will be direct credited into your nominated account
Cancelof

Declaration and Consent
In making this funding application:
1. We hereby declare that the information supplied here on behalf of our organisation is
  correct.
2. We agree to provide an accountability report to the Waitomo District Council.
3. We consent to Waitomo District Council collecting the personal contact details and information provided in this application, retaining and using these details and disclosing them to Sport NZ for the purpose of review of the Rural Travel Fund. This consent is given in accordance with the Privacy Act 1993
Person 1
Name*
Position*
Signature*

Clear
Date*

DayMonthYear
Date
Person 2
Name*
Position*
Signature*

Clear
Date*

DayMonthYear
Date

Checklist

Please read and complete the following before submitting your application. Incomplete or lateapplications will not be accepted.
Have you

Completed ALL sections of the application?Checked all figures within the application?Attached a copy of your organisation’s balance sheet/financial statement?Evidence of your endorsement from your local affiliated club/school (if required)Attached a bank deposit slip (If your application is approved, payment will be direct credited into your nominated account)
Should be Empty:

Sport New Zealand Rural Travel Fund Application

Background

Rural Travel Fund Eligibility

Assessment Criteria

Organisation Contact Details

Contact Persons

First Person

Second Person

Organisation Details

Financial Details

How much money are you applying for?

If yes, what please detail below

Travel Information

Required documents

Declaration and Consent

Person 1

Person 2

Checklist