Grant Application

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Grant Application

Your Organisation's Details

Name of Applicant Organisation *

This should be the same as the bank account name.

Organisation Address *

Street address and PO Box number

Phone *

Email

Contacts

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

Contact Name *

Role *

Cell Phone Number *

Contact Name *

Role *

Cell Phone Number *

Grant Amount

Total Amount Requested from ILT in words *

$ *

About The Grant

What is the grant to be used for? *

Please be specific about the detailed use of the grant.

Is funding request for Wages? *

Yes

No

Wage Funding

Name of Employee & Role *

e.g. Joe Blogs, Coach

Annual Salary Amount * $

e.g. $50,000

Total Requested Amount * $

e.g. $10,000

About Your Organisation

What is the purpose of your organisation? *

How many people belong to the organisation applying? *

Please explain how you calculated this number *

How many people would benefit from this grant? *

Please explain how you calculated this number *

Please detail how people will benefit from this grant *

What is the legal status of your organisation? *

Please describe your legal status: *

Does your organisation work with children? *

Do you have a Child Protection Policy? *

Is your organisation registered with the Charities Commission? *

Charities Commission registration number *

Are you GST registered? *

GST No. *

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. *

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

For applications made prior to 1 April 2021, please include a note advising how Covid-19 has affected this year's budget and what changes you have made because of this.

Most recent financial statement *

(if currently being audited, please provide a draft copy). NB: Financial information on reserves/cash on hand/investments must be included
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx xls xlsx.

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

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 *

Yes

No

Details on other funding received

Received From:

Purpose Given For

Amount

Bank Details

Applicant Organisation's Bank *

Branch *

Account Number *

Name of Account *

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.

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

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

Name *

Position *

Signature

Clear signature

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

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

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

Name *

Position *

Signature

Clear signature

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

Leave this field blank

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