LuflJ APPLICATION FOR COMMUNITY GRANT JJL Community Board =tion 2-/zZ,A2,/e ;t—d Contact name Postal Position—/j-address/3 t' Telephone number include area code Email i1ves Is your organisation a legally constituted incorporated society? NO What are the goals of your organisation? - --'— __ -Z e,-ey Describe the specific purpose the community grant funding is required for. Page 2 Please detail the complete cost of the project. ITEM. Deso iption of project costs COST (T $ $ — / —V -/ _Ij : Total $ How much are you applying for? $ - Please specify where the remaining funding will come from. /t - Have you received any funding from any Government agency in the past three years? If so please detail below. Please advise if your organisation is under the umbrella of a national organisation. Please outline how your project will benefit the community. r' L --L''------ .-.--.—'- I - / Please add any further information you consider may assist with your application Please enclose the following with your application form If your organisation is registered for GST, please supply your GST number. ['(budget projection for the next 12 months. 1 D__L] ELI-] In making this application I declare that: 1. 1 a authorised to do so. 2. To the best of my knowledge all key information has been disclosed and all information in the application is true and correct. 3. If the application is successful, agree to enter with good faith into a Service Level Agreement or to complete an Expenditure Declaration stating how the Community Grant has been expended with the Community Board. I agree with the declaration stated above, for and on behalf of the organisation. 11_1~ /%.Lc,4 Name/f2(Full c/'6t Designation '-.-'.' Signed ,/ Date (DD/MM/YYYY) Please send your completed application to: Community Grants Thames-Coromandel District Council Private Bag Thames 3540 THAMES COROMANDEL DISTRICT COUNCIL Guidelines for Applicants Schedule A: Community Board Grants Criteria 1. Financial assistance will only be available for locally recognised organisations within the Thames-Coromandel district whose principal functions and/or activities are of a charitable (not-for-profit) nature. 2. Preference will be given, but not limited to, organisations that are registered as an Incorporated Society to qualify for Community Grant funding. 3. Applications will be considered on a. merit b. benefit to the community C. contribution to the achievement of Council Outcomes, and/or contribution to the achievement of Community Board priorities d. total cost of the project, event or funding request and proportion of funding requested as a % of total cost. 4. Where a grant is for an event, the event criteria (outlined in Schedule B) also applies. 5. Financial assistance will only be available for a specific project or for the maintenance of a facility, which is of benefit to the community. Community Grants are not for the payment of wages/honorariums or usual operational expenditure. 6. Evidence of other fund raising undertaken and commitment of reasonable percentage of own funds to the project or initiative must be provided. 7. Community grants can be used to cover Council-related expense (for example, hall hire). 8. The responsibility of Central Government towards organisations will be taken into account when considering grants for a project that the organisation may already have received funding from Central Government. 9. All applications must be accompanied by a statement of financial position for the previous financial year and a budget projection for the next financial year. 10. All applications must declare any conflict of interest that may exist with the Council, if relevant. 11. All successful applicants must acknowledge the support of the Thames-Coromandel District Council on any correspondence, advertising or other publicity material. 12. Applications must be made on the Thames-Coromandel District Council Community Grants Application Form. 13. Late applications will NOT be considered or carried forward. 14. Any Community Grant funds not spent on the project for which the funds were applied for by the close of the Council's financial year must be returned to the Thames- Coromandel District Council unless written approval to retain the funds is obtained from the relevant Community Board. 15. At the completion of the expenditure every successful recipient must provide a detailed expenditure declaration and a report on the community benefit achieved (or similar). Council Outcomes On behalf of the Coromandel Peninsula, the Council will aim to achieve: • A Prosperous District • A Liveable District • A Clean and Green District What do these Council Outcomes mean? A Prosperous District The Coromandel Peninsula has a prosperous economy. This means the Council will focus its efforts on... • Providing for economic and population growth that is socially and economically sustainable • Helping create an environment that enables our economy to grow • Making it easy to create opportunities and jobs • Maximising economic opportunities from the Peninsula's natural setting A Liveable District The Coromandel Peninsula is a preferred area of NZ in which to live, work, raise a family and enjoy a safe and satisfying life. This means the Council will focus its efforts on... • Providing infrastructure to help build healthy communities • Supporting a range of recreation and leisure opportunities • Advocating for our communities needs • Encouraging community responsibility • Supporting a choice of lifestyle opportunities • Making it easy to get around • Promoting development of a safe living environment • Respecting and nurturing a local sense of place • Promoting and valuing the districts historical and cultural heritage A Clean and Green District The Coromandel Peninsula's natural environment provides a unique sense of place This means the Council will focus its efforts on... • Providing for our unique environment to be protected • Balancing environmental protection with accessibility • Ensuring future development fits sensitively within the Coromandels unique landscape and coastal environment • Implementing and supporting appropriate land use management • Having a balanced regulatory framework that protects important community and environmental values without imposing uniformity and inflexibility • Playing its part in keeping our environment safe and clean Schedule B: Community Board Events Criteria Where a grant is for an event, the following criteria applies. This criteria also applies where a community board conducts a specific "event funding" process. Assistance will only be available for locally run community events within the Thames- Coromandel district, whose principal functions and/or activities are of a charitable (not for-profit) nature. 2. Preference will be given, but not limited to, organisations that are registered as an Incorporated Society to qualify for Community Grant funding. 3. The Events fund is not for the payment of wages or honorariums. 4. Only one grant per organisation, per event, will be available in any financial year. 5. Consideration to be given to the viability of the event as a whole and fundraising efforts already shown (for example, Business Plan, marketing strategy). 6. All applications must be accompanied by a statement of financial position (if available) for the previous financial year and a budget projection for the event. 7. Applications must be made on the form available (Community Events Application Form). 8. All successful applicants must acknowledge the support of the Thames-Coromandel District Council on any correspondence, advertising or other publicity material. 9. Any Community Event funds not spent on the project for which the funds were applied for by the close of the Council's financial year must be returned to the Thames- Coromandel district Council unless written approval to retain the funds is obtained from the relevant Community Board. 10. A report on the success of the event and evidence that the grant was spent appropriately to be provided to the Board within three months of the event. Council Outcomes On behalf of the Coromandel Peninsula, the Council will aim to achieve: • A Prosperous District • A Liveable District • A Clean and Green District What do these Council Outcomes mean? A Prosperous District The Coromandel Peninsula has a prosperous economy. This means the Council will focus its efforts on... • Providing for economic and population growth that is socially and economically sustainable • Helping create an environment that enables our economy to grow • Making it easy to create opportunities and jobs • Maximising economic opportunities from the Peninsula's natural setting A Liveable District The Coromandel Peninsula is a preferred area of NZ in which to live, work, raise a family and enjoy a safe and satisfying life. This means the Council will focus its efforts on... • Providing infrastructure to help build healthy communities • Supporting a range of recreation and leisure opportunities • Advocating for our communities needs • Encouraging community responsibility • Supporting a choice of lifestyle opportunities • Making it easy to get around • Promoting development of a safe living environment • Respecting and nurturing a local sense of place • Promoting and valuing the districts historical and cultural heritage A Clean and Green District The Coromandel Peninsula's natural environment provides a unique sense of place This means the Council will focus its efforts on... • Providing for our unique environment to be protected • Balancing