Grant Application

Your Organisation's Details

Name of Applicant Organisation(Required)

Organisation Address(Required)

Street Address City ZIP / Postal Code

Phone(Required)

Email(Required)

Contacts

Please supply two contacts from your organisation with a brief description of their roles and their mobile numbers.

Contact Name(Required)

First Last

Phone Number(Required)

Role(Required)

Contact Name(Required)

First Last

Phone Number(Required)

Role(Required)

Grant Amount

Total Amount Requested from ILT in words(Required)

Dollar Amount $(Required)

About The Grant

What is the grant to be used for?(Required)

Please be specific about the detailed use of the grant.

Is funding request for Wages?(Required)

Yes

About Your Organisation

What is the purpose of your organisation?(Required)

How many people belong to the organisation applying?(Required)

How many people would benefit from this grant?(Required)

Please detail how people will benefit from this grant(Required)

What is the legal status of your organisation?(Required)

Please state other(Required)

Does your organisation work with children?(Required)

Yes

Do you have a Child Protection Policy?(Required)

Yes

Is your organisation registered with the Charities Commission?(Required)

Yes

Are you GST registered?(Required)

Yes

What is your NZ Business Number?

(refer www.nzbn.govt.nz)

Budgets

Organisation's approved budget (income & outgoings) for the coming 12 months. If funding is for a specific event, please also attach a separate event budget.

Drop files here or

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.

Most recent financial statement

Drop files here or

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.

If your application is for a one off project or event, please also attach two quotes for costings.

Drop files here or

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.

Please include details on fundraising you have done or intend to do, towards the funding applied for.

Has the organisation applied for, or received funds, in the last 12 months from any other source? i.e. CTS, ICC, Lotteries, MSD, MBIE, Government Wage Subsidy, Sponsorships(Required)

Yes

Bank Details

Applicant Organisation's Bank(Required)

Branch(Required)

Account Number(Required)

Name of Account(Required)

Personal account are not permitted.

Declaration

We declare that the information provided in this grant application is true and correct, to the best of our knowledge, and we have the authority to make the application on behalf of the applicant.
This organisation fully understands that any and all grant monies received from the ILT can only be used for the purpose for which the grant was approved. Copies of invoices, receipts and bank statements (where applicable), along with any unspent funds, will be returned to the ILT after the funds have been applied towards the purpose for which the grant was made.
We authorise the ILT to retain information pertaining to this application and to disclose that information as deemed necessary by the ILT for any purpose, including the publication of grants.
We have read, understand and accept all the conditions applicable to this application for a grant. The funds will only be used for the purpose applied for in this application.

Agreement(Required)

I have read the above declaration and understand the conditions of this application

If you are unable to provide the second signature at the time of application, please click on the Save and Continue Later button below to generate a URL.

Copy and send this URL to the second person for them to sign and complete the form.

Name(Required)

Position(Required)

Signature(Required)

Please use your mouse to sign in the signature box above.

Signature(Required)

Please use your mouse to sign in the signature box above.

If you are unable to provide the second signature at the time of application, please click on the Save and Continue Later button below to generate a URL.

Copy and send this URL to the second person for them to sign and complete the form.