Ann Sinclair Trust
Organisation Application Form
Did your organisation receive a Grant Last Year?
*
We completed a Grant Evaluation Form for last year’s grant
We did not receive a grant last year
We did not complete a Grant Evaluation Form for last year’s grant and would like to do so now
Click on this link
to access the Evaluation Form for last year's grant
Name of Organisation
*
Region that your organisation is located in
*
Please Select
Taranaki
Manawatu-Whanganui
Wellington-Wairarapa
Charities Registration
Is your organisation registered with the Charities Commission?
Charities Registration Number
Contact Name
*
First Name
Last Name
Contact Address
*
Street Address
Street Address Line 2
City
Region
Post Code
Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email
*
example@example.com
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Project Name
*
General description of project
*
Supporting documentation
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Please attach any supporting documentation that you would like to provide
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Outcomes and Measures
Specify THREE outcomes you will use to measure the success of your project
*
Timing of Project
Proposed Start Date
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Duration of Project
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Grants previously received from Ann Sinclair Trust:
Sources of Funding
Existing funds available for project
*
Are you applying for funds from elsewhere?
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How will the project be sustained when Ann Sinclair funding ceases?
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Breakdown of what the Ann Sinclair Trust grant would be used for
*
Total Grant Amount Applying For
Total Project Cost
Bank Account Number
Format: NN-NNNN-NNNNNNN-NNN
Proof of bank account
*
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Please attach bank deposit slip or other proof of bank account (verified/stamped/signed by bank staff)
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Authorised Persons
Name 1
*
Signature 1
*
Name 2
*
Signature 2
*
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