Grants - Genesis Tekapo Township Grant Application Form

Genesis Energy has an agreement with Mackenzie District Council in relation to water rights and provides funding to the council annually under this agreement for the promotion of the Tekapo township.

Funding of up to $15,000 per year is available via a process administered by the Mackenzie District Council and the Tekapo Community Board.

Closing Date

Applications closing date for 2024 to be advised.

Part 1: Applicant details

Are you applying as an individual or group? (Required)	Individual Group
Full name of applicant (Required)
Contact person (for a group)
Street address / PO Box number (Required) All correspondence will be sent to the above email or postal address.
Suburb
Town/City (Required)
Postcode (Required)
Country (Required)
Email (Required)
Telephone (day) (Required)
Name on bank account (Required)
GST number
Bank account number (Required)
Would you like to speak in support of your application at the Tekapo Community Board meeting? (Required)	Yes No
Applicant Date of Birth

Part 2: Project details

Project name (Required)
Brief description of project (Required)
Venue and suburb or part of town (Required)
Start date (Required)
Finish date (Required)
Number of participants (Required)
The idea / Te kaupapa What do you want to do? (Required)
The process / Te whakatutuki How will the project happen? (Required)
The people / Ngā tāngata Tell us about the key people and/or the groups involved. (Required)
The criteria / Ngā paearu Tell us how this project will deliver promotion of the Tekapo Township? (Required)

Part 2b: Project details - budget

Are you GST registered?

(Required)

Yes - Do NOT include GST in your budget
No - Include GST in your budget

Project costs

(Required)

Write down all the costs of your project and include the details, eg materials, venue hire, promotion, equipment hire, artist fees and personnel costs.

Item eg hall hire

Detail eg 3 days’ hire at $100 per day

Amount eg $300

Project Income

(Required)

Write down all the income you will get for your project from ticket sales, sale of artwork, other grants, donations, your own funds, other fundraising. Do not include the amount you will be requesting from Tekapo Township Project.

Income eg ticket sales

Detail eg 250 tickets at $15 per ticket

Amount eg $3,750

Total Income

(Required)

Costs less income

Amount you are requesting from the Tekapo Township Project

(Required)

Tell us about any other funding you have applied for or received for this project

(Required)

Date applied

Who to

How much

Confirmed / unconfirmed

Tell us about other previous Genesis Tekapo Township Project grants you have received in the past three years.

(Required)

Date

Project title

Amount received

Project completion report submitted (yes/no)

Financial Statements - supporting documents

Groups or organisations must provide a copy of their latest financial statement. This can be a copy of the audited accounts, an income and expenditure statement or a copy of the unaudited management accounts.

If your group or organisation has reserves which are not being used for this project you should include your reserves statement or policy

Please upload in either PDF, PNG or JPG formats.

Part 3: Declaration

We declare all information is correct

You must read and sign the following. Please select each box to show that you have read the information and agree to each section.

(Required)

I/We declare that the details contained in this application are correct and that I/we have authority to commit to the following conditions.

If this application is successful, I/we agree to:

(Required)

complete the project as outlined in this application (or request permission in writing from the Tekapo Township Project Administrator for any significant change to the project)
complete the project within a year of the funding being approved
complete and return a project report form (this will be sent with the grant approval letter) within two months after the project is completed
return any unspent funds
keep receipts and a record of all expenditure for seven years
participate in any funding audit of my organisation or project conducted by the Mackenzie District Council
contact the Tekapo Township Project administrator to let them know of any public event or presentation that is funded by the scheme
acknowledge Genesis Energy funding at event openings, presentations or performances
use the Genesis Energy logo in all publicity (eg poster, flyers, e-newsletters) for the project and follow the guidelines for use of the logo.
I understand that the Mackenzie District Council is bound by the Local Government Official Information and Meetings Act 1987
I/we consent to Mackenzie District Council recording the personal contact details provided in this application.
I/we understand that my/our name and brief details about the project may be released to the media or appear in publicity material.
I/we undertake that I/we have obtained the consent of all people involved to provide these details.
I/we understand that I/we have the right to have access to this information. This consent is given in accordance with the Privacy Act 1993.

Checklist

Before submitting your application, complete this checklist

(Required)

My project promotes Tekapo township
My project takes place in the Mackenzie District
I have answered all of the questions in this form
I have provided quotes and other financial details
I have provided other supporting documentation
I have read and signed the declaration
My project complies with all relevant rules and regulations as required
I have made a copy of this application for my records - please note that a copy of this application will be emailed through to you upon submission

Privacy Statement

View the Mackenzie District Council Privacy Policy and Statement

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