FCC Regina Spirit Fund. Your project. Profile.

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1 Page 1 of 5 FCC Regina Spirit Fund Print You have four hours to complete your application. This form will time out after four hours of inactivity, so we recommend you begin by printing a copy. Click on Printable Form in the top right corner of your screen. Applications cannot be saved so we recommend you print a copy before you click the Submit button. Submission deadline is 11:59 PM on February 14, Only online applications will be accepted. Late or incomplete applications will not be accepted. Thank you for your commitment to Regina. Press Next to begin. Your project Mouse over instructions for definitions. * Project name Organization * What is the purpose of your organization? (100 characters or less) Profile Mouse over titles to view definitions. Select the answers which best represent your organization. * Amount of funding request (Enter the amount of funding you are requesting from FCC. Capital investment and capital improvement projects are eligible for up to $25,000 in funding. All other projects are eligible for up to $10,000.) * When did you start fundraising? * Completion date of your project * Will your project be completed by December 31, 2019? * What is your charitable organization or non-profit registration number? ( RR0000)

2 Page 2 of 5 If you are a registered charity applying using your parent or umbrella organization's registration number, provide the name, phone number and address of the parent or umbrella organization and ensure you have permission to apply using that number. * Is it your organization s mission to directly support one or more of these groups? If so, which one(s)? * How did you hear about the FCC Regina Spirit Fund? Select all that apply. Aboriginal Peoples members of visible minorities persons with disabilities women not applicable Postcard Poster FCC Employee Word of mouth Newspaper Radio/TV Internet/FCC website Social media * Will the requested funds be used for construction activities or expansion of a building? Provide the square footage of the project, if applicable * Please summarize your project in one sentence. For example: To provide nutritious snacks and lunches to school children who can t afford to bring their own to school. (140 characters or less) General Questions Select your best answer for each section. * Describe the need or opportunity that exists for your project, including how it will enhance the quality of life for people living in Regina. * Explain your project, including a description of its current status and specifically how the money from the FCC Regina Spirit Fund will be used. *

3 Page 3 of 5 If FCC chooses to support your project, how will you promote our participation? Select all that apply. media release press conference promotional materials announcement at grand opening or event banners newsletter recognition in print ad website recognize FCC in the official building or project name permanent signage (required) social media (Facebook, Twitter, etc.) * How often will your project be used? daily throughout the year (180+ days per year) daily in certain seasons ( days per year) once or twice a month (25-49 days per year) less than 25 days a year * Which category does your project fall under? fulfilling basic needs (clean air, food, shelter, warmth) safety and security, environment, health care education and social advancement community and recreation arts and culture * How are community volunteers involved in your project? * What obstacles or challenges may interfere with the completion of the project? * How will the money from the FCC Regina Spirit Fund be used? Capital investment or improvement: fixed assets (buildings, equipment) Programs - at least one month long (lunch program) Events - under one month long (festival) * A direct beneficiary of a project is someone who uses or participates in a project. How many people will be direct beneficiaries of your project each year? * Describe the direct beneficiaries and how they will benefit. * Is it your organization's mission to directly support one or more of these groups? Aboriginal People

4 Page 4 of 5 Visible Minorities People with disabilities Women Not applicable * What is the total cost of the project? * What is the total amount of funds received to date? * What is the breakdown of funds received to date? (grants, fundraising activities, private donations and in-kind donations) * Complete the following sentence: Funds received to date PLUS the amount requested from the FCC Regina Spirit Fund represent: 100% of the funding for the entire project (or specific phase outlined) 76-99% of the funding for the entire project (or specific phase outlined) 51-75% of the funding for the entire project (or specific phase outlined) 26-50% of the funding for the entire project (or specific phase outlined) 0-25% of the funding for the entire project (or specific phase outlined) Contact form Mouse over titles to view definitions. Please provide the contact details of a person who holds a permanent position in the organization. * Salutation * First name * Last name Organization * Mailing address * City * Province * Postal code * * Confirm * Organization's telephone number

5 Page 5 of 5 Your comments This is your chance to provide additional information about your organization or your project that you believe should be considered during the evaluation of your request. Terms and conditions Do you consent to receive electronic messages from FCC about the FCC Regina Spirit Fund? Yes No Your application is now ready to submit. You may review or print it before submitting by clicking on the link below. To edit your document, use the Previous button on this page. Engineered by SPONSORIUM