$5000 and Under Application Form

Fields marked * are required

Before completing the application form, your organisation must have completed the Council's Organisation Registration Form [DOC 294KB]. Please download and email to communitygrants@ccc.govt.nz.

Your organisation only needs to complete this form once, regardless of how many funding applications you will be making.

Please be aware of the following:

The online application form below cannot be saved so must be completed in one sitting.
You should review this form and prepare all the answers before you begin.
For your own records, please print this form when completed, before you press submit.

Section 1: Applicant's details

1. Name of group or organisation *

2. Main contact

First name *
Last name *
Position in group *
Phone number (daytime) *
Email *
Preferred contact method *

Section 2: Project details

3. Name of project *

4. Which funding scheme are you applying to?

Funding scheme *

Select the funding scheme you are applying under.

5. Please estimate which Council wards the participants of your project reside in *

6. How many people will directly benefit from the project? *

7. Brief description of the project *

(maximum of two paragraphs)

8. Who are the main target groups for this project? *

(eg. Older adults, people with disabilities, young people, people from ethnic minorities, etc)

9. Staff *

(for this project only)

Number of paid staff
Number of volunteers
Total volunteer hours

10. Contribution to Council Funding Outcomes *

Please tick which Funding Outcomes your project aligns with

Support, develop and promote capacity:
Community participation and awareness:
Increase community engagement:
Enhance community & neighbourhood safety:
Provide community based programmes:
Reduce or overcome barriers:
Foster collaborative responses:

Section 3: Project Budget

11. Other sources of funding of applications for the project

12. Income (for this project only)

Item	Amount ($)
Funds on hand
User fees / registration fees
Sponsorship
Total of other grants (from box above)
Other eg. fundraising

Expenditure (for this project only)

Item	Total cost ($)	CCC funding sought ($)
Salaries and wages
Administration
Power
Volunteer expenses
Equipment / Materials
Hui, conferences, meetings
Training / Upskilling
Telephone and internet
Rent / Venue hire
Travel
Other

Section 4: Declaration

I/we confirm that this application has been approved by the appropriate authorising body of the organisation, and that this has been minuted at an appropriate Board/Committee meeting.

I/we have read and accept the Christchurch City Council's Grant Terms and Conditions.

For the purpose of processing this application and assessing our group's eligibility, we authorise the Council to:

Collect information about this application and our group from, and disclose such information to, third parties;
and
Collect, retain, use and disclose personal information about individuals who are noted in this application. We confirm we have consent to authorise this.

I/we solemnly declare that the details contained in this application are true and correct to the best of our knowledge and we have authority to commit to the above conditions.

Authorising Unit: Information Management and Communications Technology

Last reviewed: Monday, August 16, 2010

Next review: Tuesday, August 16, 2011

Keywords: community funding

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