Application for Donation
*Applications must be submitted at least 1 month prior to the event date.*
1. Applicant Information
a) Organization Information
Organization Name
*
Organization Mailing address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization Phone Number
*
Please enter a valid phone number.
Organization E-mail Address
*
example@example.com
Organization President/Chairperson Name
*
Organization President/Chairperson Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization President/Chairperson Phone Number
Please enter a valid phone number.
Organization President/Chairperson E-mail Address
example@example.com
b) Individual Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
2. If the applicant is:
a) An organization or group, is it a registered society in good standing?
Yes
No
If not is good standing, please explain.
If your organization is a registered society, please provide the Town with a copy of your society’s letter of incorporation.
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b) If the applicant is an organization, it it:
Not-for-profit
Other
If other, please explain.
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3. Donation Information
NOTE: Requests for donation of space for licensed events using Town facilities as defined in the Town of Inuvik Donation and Sponsorship Policy are not eligible for donation. Please see the policy for full details.
a) If the donation request is for space at a Town facility, please provide details (dates, description of space needed, type of event being held, equipment/supplies needed, etc.)
If the request is for something other than 3 a) please explain:
Total cost of event, project or program being promoted:
*
Have you received donation/donation in‐kind assistance from any other organization, individual or government agency?
*
Yes
No
If yes, please list all organizations, individuals and government agencies from which you have received or are about to receive assistance from and specify the dollar value of that assistance.
What monies are you or your organization committing or raising towards the event, project or program you are sponsoring?
*
Have you previously applied for and received donation/donation in‐kind funding or support from the Town of Inuvik?
*
Yes
No
If yes, please specify when and the amount of donation/donation in-kind assistance received?
For what purpose?
Have you previously applied for and been refused donation/donation in‐kind funding or support from the Town of Inuvik? If yes, please explain.
*
Are any of the financial proceeds from the event, project or program you, your organization or group are sponsoring going to be donated to other groups or organizations in Inuvik? Please specify the name of the Group/Organization and the Amount of Donation for each Group/Organization.
*
In order for the Town of Inuvik to process your application for donation, you may be required to provide the following financial information:
a) a copy of your group or organization’s current budget; and, b) a copy of your group or organization’s latest audited independent financial statements prepared by an auditor who is entitled to engage in public practice under the Chartered Professional Accountants Act. If the information is unavailable you will provide an explanation as to why.
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4. You, your group, or organization agree to abide by and provide the Town of Inuvik with all the necessary information it requires in order to process this application. This includes requested financial information. Any misrepresentation or material omission on this application can result in the application being declined.
5. Organizations requesting donations from the Town of Inuvik that require Council approval under the Donation and Sponsorship Policy shall ensure that a representative is present at the Council meeting to answer questions or provide additional information. Council reserves the right to postpone making a decision until such time as a representative is available to attend.
6.You, your group or organization will be required to provide the necessary public liability and all perils insurance coverage if required by the Town in order for the Town to provide any donation/donation in‐kind assistance for your event, project or program.
7. You, your group or organization hereby agrees to save harmless the Town of Inuvik from any claim, counter claim, damages or lawsuit arising from you or your group or organization’s sponsoring of this event, project or program.
8. I/we agree to provide the Town of Inuvik with a follow‐up report if requested.
I,
*
First Name
Last Name
on behalf of
*
do hereby declare that I have the authority and approval to make the above donation/donation in‐ kind application for assistance from the Town of Inuvik.
9. Contact Person
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Signature
*
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