Coast Initiatives Fund Application: Complete form

*- indicates required field.

Please complete this application to apply for funding for coast community initiatives. Pūtea mō ngā kaupapa hapori rohe.

Part 1: Applicant Details

Full name of organisation: *

Contact person: *

Relationship to organisation: (optional)

Your address: *

Your daytime phone: *

This may be the same as your mobile number.

Your email: *

All correspondence will be sent to the above email or postal address.

Name on bank account: *

Bank account number: *

If you are successful your grant will be deposited into the bank account number you have provided if a verified deposit slip is included in this application.

You can upload a copy of a verified deposit slip here if you choose: (optional)

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(pdf, doc, docx, txt, jpg, jpeg or png)

Would you like to speak in support of your application at the Coast Community Board meeting? *

Application requirements:

1. Deliberations on grant money applications will be conducted by the Coast Community Board and must meet criteria approved by the Board, see part 3 Application Criteria.

2. Applications must be received by the Ōpōtiki District Council a minimum of 3 weeks before the Coast Community Board meets, at which a grant decision is required.

3. Applications must be received in a timely fashion to allow a grant decision to be made prior to the anticipated date of expenditure for which funding is requested.

4. Grant applications will only be considered from organisations and not (an) individual(s).

5. Applications will only be accepted from those organisations that are established within the Coast ward. If such an organisation proposes to provide assistance funding from a Coast Initiatives Fund grant then the reasons shall be outlined in the application.

6. Grant money shall only be paid on submission of an invoice with a verified bank account deposit form and GST number (if GST registered) details on the organisation’s invoice.

Part 2: Project Details

Event / Project name: *

Brief description of event / project: *

The venue or place where the event / project will take place: *

Date of event: *

Date grant requested: *

Event / Project details

1. The idea / Te kaupapa - What do you want to do? *

2. The process / Te whakatutuki - How will the project happen? *

3. The people / Ngā tāngata - Tell us about the key people and/or the groups involved: *

4. Timeframe / Taima - Tell us what the expected timeframe for completion of your project is: *

5. The budget / Ngā pūtea

Are you GST registered? (optional)

If you are GST registered - Do NOT included GST in your budget.

If you are not GST registered - Include GST in your budget.

Project costs - List all the costs of your project and include details of items this covers.

Project costs

Item (e.g. hall hire): (optional)

Detail (e.g. 3 days hire at $100 per day) (optional)

Amount (e.g. $300) (optional)

Total costs: *

Amount requesting from the Coast Initiative Fund: *

Upload quotes for your project costs (where applicable): (optional)

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(pdf, doc, docx, txt, jpg, jpeg or png)

Have you applied to any other organization for funding for the same purpose as this application? *

If your application is approved it is part of the criteria that a written report along with photos will be submitted to the Community Funding Initiative committee within one month of the project being completed.

Part 3: Application Criteria

The Coast Community Board has adopted the following criteria in assessing funding for projects:

1. The types of project/event which will be considered for funding are;

• Marae facility development and upgrades excluding projects, or components of projects, that can attract funding from other funding sources.

• Community facilities and sports fields.

• Pride and beautification projects within the community.

• Community events.

• Coastal access excluding private access.

• Infrastructure projects specific to coastal communities that may be outside of Council's immediate priorities or that may add value to existing initiatives.

• Education and training for organisations, or members of organisations, resulting in ongoing benefit or increased opportunities to the coast community.

2. In preparing to assess applications to the CIF the Community Board Members shall at all times give due consideration to:

• The Model Standing Orders for meetings of the Opotiki District Council on the matter of pecuniary (i.e. financial) interest; and

• The Opotiki District Council Code of Conduct in regard to conflicts of interest.

Part 4: Declaration

You must read and agree to the following. Please check each box to show that you have read the information and agree to each section.

I/We declare that the details contained in this application are correct and that I/we have authority to commit to the following conditions. *

I/We agree to the application requirements stated in application details on page one. *

If this application is successful, I/we agree to:

complete the project as outlined in this application (or request permission in writing from the Coast Community Board for any significant change to the project). *

utilise funding within two years from the date of approval (failure will require applicant to reapply). *

return a project report within one months after the project is completed (failure may lead to further funding applications being declined). *

return any unspent funds. *

where applicable (e.g. where items are purchased) receipts and/or written quotes shall be provided to Council. *

acknowledge Coast Initiative Funding at event openings, presentations or performances and provide photos. *

I understand that the Opotiki District Council is bound by the Local Government Official Information and Meetings Act 1987. *

I/we understand that my/our name and brief details about the project may be released to the media or appear in publicity material. *

I/we undertake that I/we have obtained the consent of all people involved to provide these details. *

I/we understand that I/we have the right to have access to this information. This consent is given in accordance with the Privacy Act 1993. *

To sign your agreement print name of contact person/applicant here: *

(If applicant is under 16 years of age parent/guardian to print name here to show agreement): (optional)

Date: *

If you have any other supporting information you would like to include with your application upload it here: (optional)

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