APPLICATION FOR ASSISTANCE: SPORT AND RECREATION GRANTS & CONTRIBUTIONS PROGRAMS

Transcription

1 & CONTRIBUTIONS PROGRAMS INSTRUCTIONS 1. Application deadline for the first call is March 31 st. 2. Please print or type when completing this form. 3. Attach a additional documentation including quotes and letters of reference 4. Use additional pages if more space is needed CONTACT INFORMATION: Grants and Contributions Officer, Sport and Recreation Division Department of Community P.O. Box. 440 Baker Lake, NU X0C 0A0 SportandRecreationGrants@gov.nu.ca Phone: (867) Fax: (867) Applications submitted to any address other than the ones listed above will not be considered. Sport and Recreation-Grant and Contribution Program* CHECK ONE BOX TO INDICATE THE PROGRAM AREA YOU ARE APPLYING UNDER: Sport Development Pool and Waterfront Contributions ** Sport and Recreation Clubs Inuit Games Support Contributions** Sport & Recreation Scholarships Volunteer Recognition Program** Nunavut Territorial Assistance Program Recreation Facility Improvements** Special Events Program Physical Activity Program Grant Sport & Recreation Skills Recreation Facility Operators Training (RFOT) Technical Development Traditional Recreational Activities Program Recreation Leaders and Volunteer Training *Territorial Sport and Recreation Organizations applying for organizational/administrative grant support complete Territorial Sport and Recreation Organizational Support Grant Application **Eligibility for these programs is limited to Municipal Corporations Note: Funding received in one year does not guarantee continued funding in subsequent years. Funding must be spent within the fiscal year for which it was awarded. On-going salaries for permanent employees will not be funded. One proposal may include multiple projects/initiatives however a separate proposal must be submitted for each program area. Page 1 of 6

2 Section A CONTACT INFORMATION Organization ONLY Name or Organization : Mailing Address : Community : Postal Code : Phone Number : Fax Number : If your organization is registered as a non-profit organization, please include Certificate of Registration and provide the following : Registration Number : Organization contact: First Name: Last Name: Position: Alternate Contact: (For both individual and organization) First Name: Last Name: Position: Phone Number : Fax Number : Individual Applicants ONLY Applicant s Name: Mailing Address : Community/Postal Code : Phone Number: Fax Number : Note: Successful individual applicants may be asked to give S.I.N. # and date of birth for payment process. Page 2 of 6

3 Section B PROJECT INFORMATION Title of proposal: Project Proposal and Schedule: Please describe the intent of your project, how you plan on carrying out your project, and your expected outcome including your start date and end date. Be sure to include how the projects within your proposal will benefit Nunavut through the promotion and development of sport, physical activity, or recreation opportunities in Nunavut. If additional space is required attach additional sheets as required. Page 3 of 6

4 Department of Community Section C - FINANCIAL INFORMATION Assistance from other sources: List financial or other assistance secured from any sources other than the Department of Community. Name of Source Contact Name Telephone Dollar Value TOTAL (1): List financial or other assistance that you have requested from sources other than the Department of Community. Name of Source Contact Name Telephone Dollar Value TOTAL (2): Total all other sources (1) + (2) : Previous Support: Please list any previous financial support you have received from the Department of Community Government Services. Funding Year Name of Project Dollar Value Page 4 of 6

5 Department of Community Section D FINANCIAL INFORMATION Budget: Provide a detailed budget breakdown indicating all costs by category for the proposal. Description Amount Budget total Less funds from other sources (page 4) AMOUNT REQUESTED from the Sport and Recreation Division Page 5 of 6

6 Letters of support & CONTRIBUTIONS PROGRAMS Section E - REFERENCES Please list the names of the persons/organizations providing the letters of support/reference for your proposal. Name Telephone Number Applicant s Statement: I hereby certify that the information contained in this application is true and correct to the best of my knowledge and belief and that I do not have any outstanding commitments resulting from any previous projects funded by the Department of Community or the Governement of Nunavut. Applicant s signature Date Witness signature Date Application Checklist: Have all sections of application have been completed? Has all supporting documentation been attached? (Letters of support and the certificate of registration for organizations) Has the application been signed and witnessed? To submit your application by , mail or by fax, please use the contact information on page 1 of this form. Page 6 of 6