Municipal Grant Application Form

This form is to be completed for all Municipal Grant Requests

Name of Organization

Submission Date

Street Address

City/Town

Postal Code

Contact Person

Position/Title

Phone Number

Email

What is your organization's status?

Charitable

Not-for-profit

Other

If Other, please describe

Authorization:

I declare that I am authorized to sign this grant request form on behalf of:

Name of Organization

Name

Position/Title

Phone Number

Signature

Clear

Date

Please provide project or event date(s) or any relevant timelines related to this request.

Grant Request, list monetary or in-kind services being requested.

What is the function of your organization (mandate and key objectives)?

Please provide an overview of the service, program or event being supported with this funding.

Please explain how this service, program or event benefits the Township of Greater Madawaska and its residents.

Does your organization use volunteers?

Yes

No

If yes, how many volunteers are involved and in what capacity? (e.g. administration, service level, etc)

Please select the target population that will benefit from this request.

Children (Ages 0-12)

Youth (Ages 13-18)

Adults (Ages 19-59)

Seniors (Ages 60+)

Number of participants benefitting from the request

1-50

51-100

101-499

500-1000

>1000

Please indicate how this will benefit Economic Development within the Township. (i.e. attraction, retention, marketing initiatives, economic impact)

Please indicate how this will benefit Community Well Being within the Township. (i.e. community support, arts and culture, recreational and leisure, health and well-being, support initiatives)

Has your organization received support from the Township in previous years?

Yes

No

If yes, please provide additional details below.

Service/Program/Event grant support was received for:

Type of grant support received:

Support Funding

In-Kind Support

Dollar ($) value received

Was Township staff support provided?

Yes

No

If yes, in what capacity?

Projected Budget:

Please fill out the projected budget for your organization’s event/initiative/project below.

Projected Revenues:

Grants - Township of Greater Madawaska

Grants - Other

Donations/Sponsorships

Earned Income

Applicant Contribution

Other (please specify)

Total Revenue

Projected Expenses:

Salaries and Benefits

Advertising and Promotion

Entertainment

Facilities Rental

Prizes and Awards

Other (please specify)

Total Expenses

Total Net Income (Deficit) Revenues less Expenses

Please attach the listed documentation to your completed application.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Documents

Most recent financial statements

If reoccurring event, the financial statement from previous year

Proof of incorporation, if applicable

Proof of insurance (required if funding is approved)

Conditions of Assistance

Any Grant funding provided by the Township of Greater Madawaska must be applied to current expenses associated with the approved project, and not be used to subsidize any other project of the applicant, or to reduce or eliminate accumulated deficits.
The Township must be notified in writing of any significant changes and/or purpose of the supported activity or If the activity or event is not completed, or does not move forward, the Township reserves the right to request the return of any grant funding provided.
Receipt of a grant does not guarantee funding the following or any subsequent
The applicant acknowledges and agrees that the Township of Greater Madawaska shall not be liable for any incidental, indirect, special or consequential damages, injury or any loss of use, revenue or profit of the organization arising out of or in any way related to the approved program/event/service.
Where applicable, the Township of Greater Madawaska must be acknowledged on promotional materials related to the funded activities/event, including but not limited to brochures, print ads, programs, posters, signage and media releases, as well as websites, e-newsletters, and social media campaigns, where possible. The Community Development Coordinator will require information from the applicant, in advance regarding what materials/ electronic formats the Townships logo will be included on to ensure compliance with the Township’s brand guidelines.
The Town of Greater Madawaska reserves the right to an onsite presence, or formal role, at the program/events. Failure to acknowledge the Township’s support may result in the inability of an organization to obtain grant support in future years.
The applicant agrees to provide proof of insurance or alternatively purchase User Facility Insurance if required.
The applicant agrees to report back to the Council on the success of the program/event.

I acknowledge that I have read and understand the Conditions of Assistance for receipt of Township of Greater Madawaska Municipal Grants. I also acknowledge that I have read and agree to follow the Township of Greater Madawaska's Municipal Grants Policy.

Signature

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