Name of Organization: Project Category (check only one): SPORT RECREATION CULTURE

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1 Sask Lotteries Community Grant Program APPLICATION Applicant has read the program guidelines: yes no (if no, read the program guidelines prior to proceeding: culture heritage/get involved/grants) Our organization would like to be included in any future correspondence regarding this grant programs or other relevant grant information from the City of Saskatoon: yes no Name of Organization: Mailing Address: Contact Name: Address: Alternate Contact Name: Address: Postal Code: Position with organization: Phone Number: Position with organization: Phone Number: Project Category (check only one): SPORT RECREATION CULTURE For Culture Projects Only (check all areas that apply): literary visual arts and crafts music media cultural celebrations heritage dance theatre Grant Amount Requested: Project Name: Total Project Amount: Project Dates: Project Location(s): Total Number of Participants: Time of Day of Project: Total Number of Project hours for participants: Day(s) of the week Project is offered: Non Profit Incorporation Number: (Applicants must be in good standing and incorporated for a minimum of one year) Name of Organization s Insurance Company: (Applicants are required to carry a minimum of $2,000,000 in liability insurance) Insurance Policy #: Sask Lotteries Community Grant Application revised August 24,

2 1. Organization Mandate and Primary Activity (maximum 150 words): 2. Please provide a brief project description or overview. (i.e. What is the project activity? Who are the participants? Where and when will the project take place? maximum 150 words) 3. What do you wish to achieve with this project? (i.e. What are your goals and objectives? maximum 150 words) Sask Lotteries Community Grant Application revised August 24,

3 4. How will you accomplish the project objectives? (i.e. What will you do and when will you do it? maximum 150 words) 5. What format will be used for this project? (check all that apply) registered program drop in program workshop performance special event other 6. In what way does your project increase participation in sport, culture or recreation? 7. a) Who is the project intended for? Sask Lotteries Community Grant Application revised August 24,

4 b) Are any of the groups below being specifically targeted? (check all that apply) Aboriginal people economically disadvantaged youth at risk persons with a disability newcomers women single parent families older Adults (65+ years) other: c) How are you targeting this group? d) Is there a fee to participate? No Yes If yes: fee/person $ Provide an explanation if applicable: 8. a) Estimate numbers of participants and gender and age range if possible. For All Ages OR Age Ranges Number of Females Number of Males Total 0 5 years (Preschool) 6 12 years (Child) years (Teens) years (Young Adult) year (Adult) 65 + years (Older Adult) Total Sask Lotteries Community Grant Application revised August 24,

5 b) What are the estimates based on? (e.g. previous years, expressed interest, etc.) 9. How do you plan to involve your target population in planning, promoting, delivering and/or evaluating your program? (check all that apply) representatives will sit on the advisory committee community consultations/focus groups will be held members of the target group will assist with delivery of the program informal contacts and conversations will be used other 10. How will you make the target population aware of your project/program? (check all that apply) newspaper ads online communications TV ads community meetings radio ads word of mouth Facebook Twitter posters in area/buildings where target population goes referral from professionals (e.g., social workers, seniors homes, schools, etc.) brochures distributed to target population other 11. How many volunteers will be involved with this project? What will they do? 12. How will you measure and evaluate that your program has achieved your objectives? (check all that apply) Number of Participants Participant Attendance (for ongoing programs) Sask Lotteries Community Grant Application revised August 24,

6 Quality of the project/event Other Value to the Participants 13. What results and/or benefits will the participants receive from this project? 14. How will you publicly acknowledge Saskatchewan Lotteries and the City of Saskatoon as the sources of funding for your project? (check all that apply) Posters Newsletter Radio Newspaper Banners TV Website Word of Mouth Speeches Facebook Twitter Other 15. Financial Summary: a) Please complete the Description of In kind Donations below. Note: An In kind donation is a gift of goods and services. In kind goods and services are typically goods and services that your organization would have to otherwise buy if they hadn t been donated. Volunteer hours are not considered in kind donations; do not include them on this page. Description of In kind Donations Value Amount TOTAL $ b) Please complete the Descriptions of Revenues and Expenses below with as much detail as you think would be helpful; remember to include the amount requested from the Sask Lotteries Community Grant. Sask Lotteries Community Grant Application revised August 24,

7 Description of Revenues Dollar Amount TOTAL $ Description of Expenses TOTAL Dollar Amount $ Sask Lotteries Community Grant Application revised August 24,

8 Information Certification Freedom of Information and Protection of Privacy The City of Saskatoon is committed to protecting the privacy and confidentiality of people s personal information. All personal information that is collected by the City is done so in accordance with The Local Authority Freedom of Information and Protection of Privacy Act. The information collected on this application will be used to administer the Sask Lotteries Community Grant Program. De identified, aggregate information will be used by Community Services for program planning and evaluation. Incident Notification The Organization shall notify the City of any incident that it becomes aware of that may result in a claim against either the Organization or the City, including, but not limited to such losses as, property damage to City assets, third party property damage, injury or death of any Organization member, employee, instructor or volunteer and any third party bodily injury. The Organization shall provide the notification to the City within 7 days of the Organization becoming aware of the incident. Indemnity The Organization hereby agrees to save harmless and indemnify the City of Saskatoon, its representatives, successors, assigns, servants, employees and agents against any and all claims, liabilities, demands, damages or rights or causes of action whatever, made or asserted by anyone arising out of or incidental to the application or to the use of any money or services provided to the Organization pursuant to the Sask Lotteries Community Grant Program. Signature In making this application, we the undersigned Board Member/Executive Director/Project Manager hereby represent to the City and declare that to the best of our knowledge and belief, the information provided in this application is truthful and accurate and the application is made on behalf of the above named organization and with the Board of Director s full knowledge and consent. Warning Any organization that intentionally or negligently makes or furnishes a false statement or misrepresentation on this application for the purposes of receiving a grant may not only have the grant denied but may be deemed ineligible for funding from any grant program administered by the City of Saskatoon for a length of time and on such terms as the City of Saskatoon, in its sole discretion, deems appropriate. I/we solemnly declare that the information provided is true and the documents submitted in support of the application, if any, are genuine and have not been altered in any way. I/we agree on behalf of the Organization that by submitting this application I/we are electronically signing the Sask Lotteries Community Grant application as follows: Name*: Board Member Executive Director Project Manager Name*: Board Member *type in names; it is not necessary to submit actual signatures; two signatories are required (one must be a board member) Sask Lotteries Community Grant Application revised August 24,

9 a completed copy of the Sask Lotteries Community Grant application form to: Label the subject line and the completed PDF of the Application Form: Comm Grant year of grant your organization name e.g. Comm Grant 2018 Saskatoon Community Organization Applicants will receive an confirming their grant application has been received (please allow 2 3 business days for confirmation). For assistance with ing your application contact: Kim Gorham Grants Administration Clerk For more information or to discuss your application contact: Kathy Allen Arts and Grant Consultant Sask Lotteries Community Grant Application revised August 24,

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