Community Support Grant Application Form

Your Contact Information
Name*

PrefixFirst NameLast Name
Phone - Day Time*

Area CodePhone Number
Phone - Evening*

Area CodePhone Number
Primary Email*
Your Organization
Name of Organization Applying*
Address*

Street Address

Street Address Line 2

CityProvince / State

Postal / Zip CodeCountry
Web Site Address (if available)
Organizational Overview
Brief Description of Organization*
Purpose of Organization*
Names of Officers/Directors*
Date of Establishment*

YearMonthDay
Programs*
Past Accomplishments*
Organizational Financial Details
Income Tax Charitable Registration Number (if applicable)
Most Recent Financial Statements

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Names of Sources Providing More Than 10% of Your Financial Support
Project Proposal Details
Description*
Expected Duration of Project*
Contribution Requested*
How The Contribution Will Be Applied*
Application Agreement
As the applicant, I/we agree that if awarded a grant from West Vancouver United Church, our organization will use the grant solely for the purposes stated in this application and will return any portion not used for those purposes. I/we will, promptly after completion of the project, provide a report detailing the use of the funds and the actual outcomes of the project. I/we will acknowledge the Church’s assistance in the organization’s general publicity and in specific publicity for the project for which the grant was made.*

Agree
Date*

YearMonthDay
Authorized Signatory*

First NameLast Name
Title
Other Comments
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Your Contact Information

Your Organization

Organizational Overview

Organizational Financial Details

Project Proposal Details

Application Agreement