Community Wellbeing Fund Application | Invercargill City Council

Before you start

Applications can only be submitted using this document. If you are unable to type into the form directly, please print a copy and complete by hand.
We recommend that you keep a copy of your completed application for your own references.
Please only upload attachments in PDF or Microsoft Word format.
You can save your changes by clicking “save and continue later”. If you don’t see your latest changes when you return via the link, press F5 to refresh your page.

Community Wellbeing Fund Application Form

Part 1 – Applicant Details

Full Name of Organisation(Required)

Mailing address(Required)

Street Address

City

State / Province / Region

ZIP / Postal Code

Country

Is your organisation’s physical address different from above?(Required)

Yes

Physical address

Street Address

City

State / Province / Region

ZIP / Postal Code

Country

Website

Legal status of organisation (e.g. charitable trust, limited liability company)

Charities commission or NZBN registration number (if applicable)

Contact person(Required)

First

Last

Contact person position(Required)

Contact person phone(Required)

Contact person email(Required)

Enter Email

Confirm Email

Alternative contact(Required)

First

Last

Alternative contact position(Required)

Alternative contact phone(Required)

Alternative contact email(Required)

Enter Email

Confirm Email

Ethnicity of applicant/group

Ethnicity of application/group (Other)

Other:

Would you like to speak in support of your application at the Community Wellbeing Fund Committee Meeting?(Required)

Yes

Part 2 – Details of the Activity

Activity name(Required)

When will your activity take place?

Please state the expected start and end dates.

Start date(Required)

End date(Required)

Are you seeking multiple years of funding?(Required)

Yes

How many years?

Please note: You can apply for a maximum of 3 years worth of funding

Please attach a relevant business case for funding over multiple years

Please only upload attachments in PDF or Microsoft Word format. Please combine files of a similar nature, e.g. if you have 5 quotes, please send altogether as one document

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 5 MB, Max. files: 2.

Venue/facility where the activity will take place(Required)

The plan(Required)

Describe the activity that you are seeking funds for. What is the need for the activity? (maximum 3000 characters)

The process(Required)

How will the activity happen? (maximum 3000 characters)

The people(Required)

Describe the key people and/or groups involved. Consider relevant details such as age, gender, ability, ethnicity of participants/audience, etc. (maximum 3000 characters)

How many people do you expect to take part in the activity?

Approximate number of participants(Required)

Approximate number of participants

Approximate size of audience(Required)

Approximate size of audience

Please describe the community benefits of your activity(Required)

These could include social, cultural, economic, and environmental benefits. (maximum 3000 characters)

Is this activity part of a larger/wider programme?(Required)

Yes

Please outline the wider programme

(maximum 3000 characters)

Part 3 – Activity Budget Information

You may upload your forecasted budget to support the information in the tables below.

Upload forecasted budget here

Please only upload attachments in PDF or Microsoft Word format. Please combine files of a similar nature, e.g. if you have 5 quotes, please send altogether as one document.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 5 MB, Max. files: 2.

Are you registered for GST?(Required)

Yes

If you are registered for GST, you do not need to include GST in your provided costs.

If you are not registered for GST, you must include GST in your provided costs.

Please enter your GST number

Please provide itemised costs for your activity(Required)

Item

Detail

Amount $

As you are registered for GST, you do not need to include GST.

As you are not registered for GST, you must include GST.

Total costs ($)(Required)

Please provide income details including how your organisation will contribute financially to your activity(Required)

Income

Detail

Amount $

Include all relevant sources of income, e.g. participant fees, fundraising, etc

Total income ($)(Required)

Costs minus income

Please note: You cannot apply for more than or equal to costs minus income as Council cannot fully fund an activity.

Amount of funding you are applying for ($)(Required)

Please note: You cannot apply for more than or equal to costs minus income as Council cannot fully fund an activity.

Significant funding requests over $25,000 will be considered in extraordinary circumstances or may only be partly funded.

Please list confirmed sources of other funding for the activity including amounts you have applied for and are awaiting confirmation

Funding Source

Confirmed Yes/No

Amount $

Have you previously received funding from Invercargill City Council?(Required)

Yes

Please list these instances below

Date

Name of Fund applied to

Activity

Amount $

How did you hear about the Community Wellbeing Fund?(Required)

How did you hear about the fund? Other:

Other:

Additional documents

If you have any additional documents supporting you application, please attach them here. Please only upload attachments in PDF or Microsoft Word format.

Please combine files of a similar nature, e.g. if you have 5 quotes, please send altogether as one document

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 2.

Part 4 – Declaration

I/We agree:

That the information supplied in this application is true and correct to the best of my/our knowledge.
That I/We have the authority to commit our organisation to this funding application.
That the details about our funding application may be shared with other local funders.
That any funding received will be used only for the activity for which it is approved.
To participate in any funding audit of the organisation as required by the Invercargill City Council.
To complete the accountability requirements and provide receipts where requested.
That I/We will provide a complete evaluation and/or report detailing the spending and outcome of the activity.
That the details about our funding application may be released to the media or appear in publicity material.
As Invercargill City Council is bound under Local Government Official Information Act 1987 and details entered in this application may be released under the act.
To Invercargill City Council collecting the personal contact details provided on this form. This consent is given in accordance with the requirements of the Privacy Act 1994.

1. Name(Required)

First

Last

Position(Required)

Date(Required)

2. Name

First

Last

Position

Date

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Before you start

Community Wellbeing Fund Application Form

Part 1 – Applicant Details

Part 2 – Details of the Activity

Part 3 – Activity Budget Information

Part 4 – Declaration

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