Grants - Community Board Grant Application - Online form

How much money are you applying for?

(Required)

$

What is this money going to be used for?

(Required)

(Briefly explain)

What are the costs of the project and where is the funding coming from?

(Required)

Cost breakdown:

$

Total Costs

(Required)

$

When will this project happen?

Have you applied for other sources of funding?

(Required)

If yes, briefly explain other sources of funding.

Would you like to speak in support of your application at the Community Board meeting?

(Required)

Are you registered for GST?

(Required)

If yes, please provide a GST Number

Supporting documents

Attach a balance sheet or financial statement, and any other supporting documents.

Please upload in either PDF, PNG or JPG formats.

Name of organisation (Required)
Contact person (Required)
Postal address (Required)
Email address (Required)
Phone (Required)

How many people belong to your organisation? (Required)
What is the legal status of your organisation? (Required) E.g. Trust, incorporated society, other.
How long has your organisation existed? (Required)
Is your organisation responsible to, or controlled by, any other organisation or authority? (Required)	Yes No

Declaration (Required)	I hereby declare that the information supplied above on behalf of my organisation is correct. I consent to the Mackenzie District Council collecting the personal contact details and information provided in this application for the purpose of considering a grant. I also consent to this completed application form being published on the public agenda of the next community board meeting. This consent is given in accordance with the Privacy Act 1993.
Name (Required)
Position in Organisation / Title (Required)
Date (Required)

How much money are you applying for? (Required) $
What is this money going to be used for? (Required) (Briefly explain)
What are the costs of the project and where is the funding coming from? (Required) Cost breakdown: Community board (this application) Other funders Your contribution $
Total Costs (Required) $
When will this project happen?
Have you applied for other sources of funding? (Required)	Yes No
If yes, briefly explain other sources of funding.
Would you like to speak in support of your application at the Community Board meeting? (Required)	Yes No
Are you registered for GST? (Required)	Yes No
If yes, please provide a GST Number
Supporting documents Attach a balance sheet or financial statement, and any other supporting documents. Please upload in either PDF, PNG or JPG formats.


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