Heritage Grant Fund - SASM Application

Heritage Grant Fund - Sites and Areas of Cultural Significance
- We collect the following personal information as part of this application:
  - Your name
  - Your property address
  - Your contact details (phone and email)
  We collect this information so we can process your grant application and communitcate with you about it.
  
  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.
- Our Goals:
  - Recognition and identification – heritage is identified and documented.
  - Retention, protection, enhancement and conservation - heritage has a level of retention, protection, enhancement and conservation that is relative to its significance and importance.
  - Celebration and promotion - heritage is valued and celebrated to ensure it is kept alive and remembered from one generation to the next.
  You can read more about Council’s heritage goals in the Heritage Policy.
  
  Support for Sites and Areas of Cultural Significance to Mana Whenua:
  
  Applies when the project:
  - Is not for a private house or business.
  - Aligns with the visions, goals and objectives of Council’s Heritage Policy.
  - Relates to a culturally significant site or area (including those listed in the District Plan). Complies with resource and building consent requirements (if applicable).
  Applies if the project:
  - Enhances, improves, protects or conserves the physical or natural environment of the site or area (e.g. planting or retaining); or
  - Improves or creates public access to the site or area (e.g. a pathway); or
  - Provides education or educational resources about the site or area (e.g. signage or other interpretational material). Grants for sites and areas of cultural significance will generally be capped at a maximum of $10,000.
  You can read more in the Heritage Grant Fund Gudelines.

Applicant Details
Applicant (we will use this person as the contact in all future correspondence)*

First NameLast Name
Organisation Name:
Role:
Email:*
example@example.com
Phone Number:*
Phone Number

Property / Site Details
Name of Property / Site:
Description of the site:
Primary Street Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Owner / Owners if different from applicant:
Phone Number
Email of Owner / Owners if different from applicant:
example@example.com

Project Details
Aim and Outline of the project:*
This should include specifics of the work planned, evidence of appropriate project management, appropriate technical supervision, sufficient resources to complete the project on time, and demonstrated ability to report back on the project results as appropriate.
YesNoUnsure
Enhances, improves, protects or conserves the physical or natural environment of the site or area (eg. planting or retaining)Improves or creates public access to the site or area (eg. a pathway)Provides education or educational resources about the site or area (eg. signage or other interpretational material)
Briefly describe how your project meets these criteria and how it provides positive benefit*

0/500
YesNoNot sure yet
Attach any supporting documents:

eg. a letter of support from Mana Whenua, Certificate of Title, supporting documents such as quotes or invoices, pictures of the site or area
Cancelof

Grant Conditions

Grants will be subject to availability of funds in any particular year.

Grants are exclusive of GST.

Grant recipients are required to report to Council to provide evidence of completion of works, including an invoice for works completed, within the financial year within which the funds were provided (i.e. by 30 June).

Applicants may receive funding in stages at Council’s discretion.

Declaration
I confirm that all the details supplied in this application form are true and correct to the best of my knowledge, and agree that:
- The information in the application and information subsequently generated in relation to the application will be available if required under the Local Government Official Information and Meetings Act 1987.
- Compliance with all applicable regulatory requirements is the responsibility of the recipient.
- Council staff may be given access to the site, if needed, to understand its cultural heritage value and the work being undertaken through the Heritage Grant Fund.
- The applicant will provide further information if this is needed to substantiate or assess the case for funding.
- No material information has been deliberately omitted or withheld from this application.
I have read, and will comply with the grant conditions that apply to the Built Heritage Incentive Fund.
Name*

First NameLast Name
Date

DayMonthYear
Date
Should be Empty:

Heritage Grant Fund - Sites and Areas of Cultural Significance

Applicant Details

Property / Site Details

Project Details

Grant Conditions

Declaration