Community Project Grant

Important Note

This form does not automatically save while you are working on it. We strongly recommend you copy and save your answers into a separate word document as you go, to ensure you don’t lose them while working on your application.

Disclaimer
Please check you have read and understood the grant eligibility requirements and funding criteria
Final funding decisions are made at the discretion of Ashburton District Council. Successful applicants’ project details may be used for publicity purposes.

Organisation Name *

Organisation Details

Organisation Overview * Provide details of your organisation and how it works. (This could include a link to your website or a brief description of who you are, what you do, projects or initiatives you have completed or are involved with. 250 words max.)

Street Address *

Address Line 2

City *

Organisational Status

Please attach your Charities Commission Number or Certificate of Incorporation if applicable.

Primary Contact Person

First Name *

Last Name *

Email Address *

Phone (Daytime) *

Secondary Contact Person

First Name

Last Name

Email Address

Phone (Day time)

Programme Dates

Start Date *

Day Month Year

Completion Date *

Day Month Year

About the Project / Programme

Project overview * Briefly describe your proposed project or initiative including planned activities and any relevant background information, including a detailed breakdown of what the requested funding will be used for. (250 words max)

Community need What community need do you propose to meet? Include an explanation of how you have established the need for this in our community?

Benefits/Outcomes * Who is specifically going to use and benefit from the proposed services or opportunities from you project/initiative, also include the benefits to the Mid Canterbury Community as a whole.

How will you measure your success * Specifically describe how you will measure the successes of your proposed benefits and outcomes as you have outlined above? ie: participation numbers, community engagement (through what mediums this was achieved?), feedback forms

Financial Information

Are you GST registered *

If yes - provide GST number

What is the amount of funding you are asking from Council?

Please complete this simple budget outline to show what the grant would fund, if successful. Click here to download.

Attach Budget outline * Maximum upload size of 10mb

What other funding are you applying for, for this project?

Organisation

Amount requested

Date results known

Voluntary Contributions

Briefly describe any voluntary effort, including an estimate of total volunteer hours, and/or donated material contributed towards this project.

What will happen if you do not receive the full amount of the grant you have requested, including how you propose to meet any funding shortfall, if applicable? *

Application Confirmation

Confirmation of bank account details * (E.g. Pre-printed bank slip) Maximum upload size of 10mb

Quotes for the project costs * Maximum upload size of 10mb

The following must be read and accepted by the Primary Contact Person listed.

I/We hereby declare that the information supplied here on behalf of myself /our organisation, to the best of my/our knowledge, is true and correct and that I/we have the authority to make this application on behalf of our group (if applicable).

I/We hereby declare that we have a Health and Safety Plan in place for the project / programme.

I/We consent to Ashburton District Council collecting the personal contact details provided above, retaining and using these details for the purpose of review of the Community Project Grant. I/We acknowledge my/our right to have access to this information. This consent is given in accordance with the Privacy Act 1993.

I/We understand that my/our project/programme details may be used for promotion of the Community Project Grant and that I/we will be contacted if Ashburton District Council wishes to use these.

I/We understand that the funds received as a result of this application may only be used for the purpose in which they were granted and that a report form with supporting invoices must be submitted to Ashburton District Council on completion of the project / programme.

Terms and conditions

By clicking ACCEPT below, you confirm that you have read and understood and accept the terms set out above. *

First Name

Last Name *

Date *

Day Month Year

You must click "SUBMIT" below for your application to be submitted.

You will receive a confirmation email once your application has been properly submitted. If you do not receive an email, please contact us at grants@adc.govt.nz before applications close.