Rohenga Tipuna Administration Grant Application Form

Rohenga Tipuna Administration Grant Application Form
Section 1: Applicant Details
Legal Name of Applicant Entity
Applicant Entity Name
Rohenga Tipuna
Legal Status
Please enter where applicable:
Postal Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Contact Person

First NameLast Name
Position
If applicable
Email Address
example@example.com
Phone Number

Area CodePhone Number
Section 2: Fundholder Arrangement

Please complete if applicable:
Will another entity hold or administer funding on behalf of your Rohenga Tipuna?
Fundholder Name
Please enter where applicable:
Contact Person

First NameLast Name
Position
If applicable
Email Address
example@example.com
Phone Number

Area CodePhone Number
Declaration

We confirm the nominated fundholder has agreed to receive and administer funding on behalf of the Rohenga Tipuna and will meet all reporting and accountability requirements.
Fundholder agreement/letter

Please upload the fundholder agreement/letter
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Section 3: Marae Endorsements

Funding is allocated proportionately based on the number of endorsed Marae within each Rohenga Tipuna. Please select the Marae below that have provided their endorsement for this application.
Rohenga Tipuna 1 - Potikirua ki Whangaokena
Rohenga Tipuna 2 - Whangaokena ki Waiapu
Rohenga Tipuna 3 - Pohautea ki Te Onepoto
Rohenga Tipuna 4 - Te Onepoto ki Rahuimanuka
Rohenga Tipuna 5 - Rahuimanuka ki Mataahu
Rohenga Tipuna 6 - Mataahu ki Kokoronui
Rohenga Tipuna 7 - Kokoronui ki Te Toka a Taiau
Marae Endorsement Letters

Please upload letters of endorsement from Marae
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Section 4: Funding Request

Maximum available based on endorsed marae support
Amount requested
Section 5: Proposed Activities and Outcomes
What are you seeking funding for?

Other
Description of Activities
What will be achieved over the funding period?
Section 6: Budget
Please upload a detailed budget

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Section 7: Previous Funding
Has your Rohenga Tipuna previously received a Rohenga Tipuna Grant?
Amount received:
Year/s:
Have all previous reports been submitted?
Section 8: Supporting Documents
Please upload the following supporting documents:
- Charitable Status Verification
- NZBN Confirmation
- Trustee/Committee List
- Resolution to apply for funding
Charitable/Incorporated Societies Verification:

Multiple files can be uploaded as supporting documentation for your application.
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NZBN Confirmation:

Multiple files can be uploaded as supporting documentation for your application.
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Trustee/Committee List:

Multiple files can be uploaded as supporting documentation for your application.
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Resolution to apply for funding:

Multiple files can be uploaded as supporting documentation for your application.
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Financial Information
Account Name
Account Number
Proof of Bank Account

Statement or Deposit Slip
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Section 9: Declaration
Applicant Declaration

By submitting this form, I declare that:
- The information provided is true and correct.
- The applicant has the authority to submit this application.
- Activities funded will align with the purposes and objectives of the Toitu Ngati Porou Trust Deed.
- Appropriate Marae endorsements have been obtained and attached.
- We agree to provide accountability reporting as requested by Toitu Ngati Porou.
Should be Empty:

Rohenga Tipuna Administration Grant Application Form

Section 1: Applicant Details

Section 2: Fundholder Arrangement

Section 3: Marae Endorsements

Section 4: Funding Request

Section 5: Proposed Activities and Outcomes

Section 6: Budget

Section 7: Previous Funding

Section 8: Supporting Documents

Financial Information

Section 9: Declaration