Get documents about "2 Grant Application Form July 2009
Document Sample
Grant Application Form
(General Operating Support)
Deadline for submitting the application: September 15th
INSTRUCTIONS
Please answer all of the questions in the order presented in this form, using the same numbering.
Please submit 4 copies of your application (1 original and 3 copies).
Please make sure you have read our Guiding principles for awarding funds which you will find on
West Island Community Shares web site www.communityshares.ca
1. INFORMATION ABOUT YOUR ORGANIZATION
Organization name:
Year the organization was founded:
Executive Director or person in charge:
Telephone number:
Contact person and contact information (if
different from person stated above):
Address (main office):
City:
Postal code:
Fax number:
Email address:
Charitable organization’s Registration
Number (please provide the Canadian
Revenue Agency CRA #)
Number of Full-Time staff:
Number of Part-Time staff:
Number of Contractual staff:
Number of Active Volunteers:
Is Executive Director Full Time? □ Yes □ No
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207, Place Frontenac, Pointe-Claire (QC) Tel : (514) 695-8694 www.communityshares.ca
List all of the members of your board of
directors
Total number of people served last year by
your organization:
Number (or %) of these people living in the
West Island:
Number of people on a waiting list:
Average length of time a person stays on
the waiting list:
Geographic area served by your
organization:
Category (list sector you organization □Health □Social Services
caters to): □Culture □Environment
2. INFORMATION ABOUT YOUR ORGANIZATION (cont’d)
a) Brief summary of your organization’s history
b) Brief statement of your organization’s mission and goals
c) Description of current programs, activities and accomplishments (community impact)
d) Organizational chart, including board, staff and volunteer involvement.
e) Provide a list of the community groups you collaborate with.
3. AMOUNT REQUESTED BY YOUR ORGANIZATION
Please indicate the amount of funding you are requesting. Historically, Community Shares has
given new groups first time funding ranging between $5,000 and $15,000.
4. DESCRIPTION OF THE REQUEST
a) Explain why your group is requesting this level of funding. Please specify if the funding
would be allocated to the general operating support of your organization or if you plan to
allocate it to a specific purpose (for example: funding would be used to add a part-time
counsellor to your existing staff).
b) Explain what kind of impact this funding would have on your programs or services.
c) What kind of impact would the following amounts have on your organization? Please be
specific in your answers.
1. $5,000
2. $10,000
3. $15,000
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207, Place Frontenac, Pointe-Claire (QC) Tel : (514) 695-8694 www.communityshares.ca
5. THE FUTURE
a) What are the major challenges or issues your organization faces over the next 2 to 3
years?
b) Do you have any expansion plans? If so, what are they?
6. STATISTICS
Please provide us with the following statistics using the table below.
People who have sought help or who have benefited from your organization’s programs
and/or services last year (your last fiscal year, or last calendar year, whichever one you
use to keep track of those you serve):
Number of people who sought your services
last year
Number of people who sought your services
last year AND that live on the West Island
Number of West Island seniors who sought
your services last year
Number of West Island children who sought
your services last year
Number of West Island families who sought
your services last year
Number of West Island men who sought your
services last year
Number of West Island women who sought
your services last year
7. LIST THE TOP 5 FUNDERS OF YOUR ORGANIZATION
1.
2.
3.
4.
5.
8. DOCUMENTS TO SUBMIT WITH THIS REQUEST
a) All of the documents that your organization handed out during its recent Annual General
Assembly, including your activity reports and statistics.
b) Your most recent audited financial statements, or your Review Engagement Report.
c) Letters of support (optional) (limit of 3)
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207, Place Frontenac, Pointe-Claire (QC) Tel : (514) 695-8694 www.communityshares.ca
9. REQUIRED SIGNATURES
This request must be signed by the Executive Director (or Managing Director/coordinator) and
by the President of your Board of Directors. Please make sure to provide the typewritten names
of the people who are signing, including the date of signing.
10. IMPORTANT INFORMATION FOR GROUPS WHO RECEIVE FUNDING
Please take a look at the graphic timeline of the Fund Distribution Annual Cycle in
order to familiarize yourself with the timeline and deadlines for submitting documents to
Community Shares.
Community groups who receive funding from Community Shares must submit the Annual
Evaluation Report by October 15 each year.
Community groups who receive funding from Community Shares are asked to include
West Island Community Shares’ logo in its communications (Web Site, pamphlets,
posters, letterhead, etc.).
Every fall, Community Shares sends out a mass mailing to over 65,000 West Island
homes. We kindly ask the recipient groups to not send out a mass mailing to West Island
homes between September 21st and November 1st of each year.
Community groups who receive funding from Community Shares are asked to mention in
their press releases that they receive funding from West Island Community Shares. This
way, our donors can better see the impact of their donations to Community Shares.
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207, Place Frontenac, Pointe-Claire (QC) Tel : (514) 695-8694 www.communityshares.ca
