Financial Assistance Grant Application Form

GENERAL INFORMATION

Mailing Address

SOCIETY INFORMATION

The number the organization puts on charitable donation receipts.
Society Executive
Title
Name
Phone Number
 
Use + sign at right to add rows for each executive member.

LOCAL CONTACT INFORMATION OF PERSON COMPLETING APPLICATION FORM

Mailing Address

GRANT APPLICATION

New or Previously Funded

ORGANIZATION INFORMATION

User Statistics

Is the organization run by volunteers, paid staff or a combination of both?

The number of paid staff, their titles and number of paid hours per year.
Number
Title
Paid Hours Per Year
 
Use + sign at right to add rows for each type of paid staff.

REQUEST FOR GRANT

Proposal is best characterized as:
Participants/beneficiaries will primarily be:
This proposal’s activities can best be described as related to:
Attach the following information:
  • Most recent audited Financial Statements including a Balance Sheet and Income Statement
  • Previous year’s actual operating budget if the most recent Financial Statements provided are not the previous year’s (Please attach a copy of the income and expense statement in a format consistent with the organization’s financial statements)
  • Operating Budget for the Current Year (Please attach a copy of the projected income and expense statement in a format consistent with the organization’s financial statements)
  • Projected operating budget for the next year
  • Copy of Non-Profit Society Registration papers
    • Drop files here or
    Accepted file types: pdf, doc, xlsx, xls, txt, Max. file size: 32 MB.

      DECLARATION

      I hereby declare that the statements and information contained in the material submitted in support of this application are to the best of my belief true and correct in all respects.

      I hereby agree to indemnify and save harmless the District of Hudson’s Hope and its employees against all claims, liabilities, judgments, costs and expenses of whatsoever kind which may in any way occur against the said City and its employees in consequence of and incidental to, the granting of this exemption, if issued, and I further agree to conform to all requirements of the applicable bylaw and all other statutes and bylaws in force in the District of Hudson’s Hope.

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      The personal information on this form is collected for the purpose of an operating program of the District of Hudson’s Hope as noted in Section 26(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection and use of this information, please contact the Freedom of Information Coordinator at 250 787 8150.