Branch Donation Request Form

Do you understand our focus of supporting local groups and organizations?* This field is required.

YESNO

Are you ready to begin the application?* This field is required.

Your Name* This field is required.

First Name

Last Name

Name of the group / organization you are representing* This field is required.This is the name that will appear on the Cheque of an approved request

Email* This field is required.Approval notice and/or requests for more info will be sent by email

example@example.com

Phone Number* This field is required.

Please enter a valid phone number.

Please select the branch(es) that your organization banks with* This field is required.

Cranbrook

Castlegar

Fernie

Sparwood

Elkford

Greenwood

Slocan Park

None

What can we call your project?* This field is required.Give us a title for it if you can

Is there a website we can visit as reference for the project or organization?* This field is required.N/A if no. If yes, please type it in below.

What is your specific role in the project, and who are some other key people involved / what are their roles?* This field is required.

Over what period is this project taking place?* This field is required.

Please explain what the project is, and why it is happening now. * This field is required.

Please explain who the project will impact, and how.* This field is required.

Please explain what will make this project a success.* This field is required.Can you measure this?

Where is this project going to happen?* This field is required.

What cities / regions will this project directly benefit?* This field is required.

Cranbrook

Castlegar

Fernie

Sparwood

Elkford

Greenwood

Slocan Park

Other

Please break down the total costs, as best you can, for us below.* This field is required.

How much funding are you requesting from StellerVista?* This field is required.

What elements of the project would these funds go toward?* This field is required.

For what date are you requesting funds?* This field is required.When do you need the cash in hand?

Date

Will this project happen without a donation from StellerVista?* This field is required.

YESNO

Which area(s) do(es) this project align with?* This field is required.

Community Building

Education & Financial Literacy

Health & Recreation

Arts & Culture

Family & Youth Programs

Regional Quality of Life

Other

How would a StellerVista donation be recognized by your organization?* This field is required.Is this something you would promote / take photos of / etc

Will you be able to send StellerVista photos and/or video of your project and the efforts leading up to its successful conclusion?* This field is required.

YESNO

Can StellerVista visit the project, at a future date, to take photos and/or videos to share online, in-branch, and trough other media sources?* This field is required.

YESNO

Are any other credit unions providing funding? If so, who and how?* This field is required.

Are any other groups or agencies providing funding to the project?* This field is required.