James Gibb Fund
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 Parish/Church
*
Parish/Church Region
*
Please Select
Taranaki
Manawatu-Whanganui
Wellington-Wairarapa
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
*
Provide details of project plan, overall strategy, objectives, evidence of need for this project and likely long term impact (no more than 300 words). This box must be completed for your application to be considered. (i.e. please do not state "see attached supporting information")
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
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Duration of Project
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Grants previously received from James Gibb Fund:
Sources of Funding
Existing funds available for project
*
Are you applying for funds from elsewhere?
*
How will the project be sustained when James Gibb funding ceases?
*
Breakdown of what the James Gibb funding 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
This application has the full support of our Parish/Church
Name 1
*
Signature 1
*
Name 2
*
Signature 2
*
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