"THE REGIONAL MUNICIPALITY"
2012 COMMUNITY PARTNERSHIP PROGRAM APPLICATION FORM FOR SPORTS/RECREATION Sports/Recreation Category: As opposed to funding general operations, Community Partnership Programs for recreation and sports will be considered for youth groups that need funding for specific purposes, programs and initiatives including, but not limited to: ACCESSIBLE PROGRAMMING FOR DISADVANTAGE YOUTH GROUPS VOLUNTEER TRAINING WHERE ADDITIONAL RESOURCES ARE REQUIRED INITIATIVES TO IMPROVE ACCESS Organization: Mailing Address: (street, city, postal code etc.) Phone #: Fax #: E-Mail: Website: Contact Person (For inquiries on this application): Title: Phone #: Program Name: ________________________________________________ Community Partnership Program Request: $ _____________* *WE WILL NOT FUND IN EXCESS OF 30% OF THE TOTAL PROGRAM OPERATING BUDGET SUBMIT BY: Friday, September 9, 2011 NO EXCEPTIONS APPLICATION SUBMISSION: SUBMIT THE ORIGINAL AND ONE (1) PHOTOCOPY (SINGLE-SIDED), NO FAXES. ATTACHMENTS ARE ONLY REQUIRED WITH THE ORIGINAL APPLICATION. Each applicant seeking Community Partnership Program funding is required to complete and submit a signed copy of the Application Form for the program for which Community Funding is being sought. The applicant must submit the original and one single-sided photocopy to the Corporate Services Department by Friday, September, 9, 2011. APPLICATIONS MUST BE SENT TO (NOTE NEW ADDRESS): c/o Rosanna Melatti, Grants Co-ordinator Corporate Services Community Partnership Program City Hall,71 Main Street West Hamilton, Ontario, L8P 4Y5 Inquiries regarding application forms can be made to: Rosanna Melatti at 905-546-2424 x4524 or email@example.com ATTACHMENT CHECKLIST: Letters of support for program/activity indicating community benefit, need, etc. (New applicants only) A list of the boards of directors. Include members’ position on the board, occupation & mailing address A brief written history of the organization Summaries of studies on file that will provide an understanding of the organization and its program(s) Additional descriptive information providing an understanding of the organization and its program(s) Most recent quantitative/qualitative evaluation of program (indicating participants served and the degree to which planned program goals and objectives were achieved) Conflict of interest policy & procedure - New Applicants must submit. If an organization receiving City funding has already submitted then ONLY SUBMIT IF IT HAS BEEN REVISED! Copy of the organization's by-laws or a photocopy of the table of contents of by-laws – New Applicants must submit. If an organization receiving City funding has already submitted then ONLY SUBMIT IF IT HAS BEEN REVISED! ONE COPY of the organization’s last completed financial statements. Council may also request audited financial statement for Community Partnership Program requests. Page 2 of 14 ORGANIZATION INFORMATION Organization mission statement: Date organization was established: Is the organization incorporated as a non-profit organization in the province of Ontario? Yes No If not, is your organization in the process of incorporation? Yes No Registered Charitable # (if applicable): Fiscal year end: Have you applied to the City of Hamilton (Tax Department) for a Charitable Rebate? Yes No If so, was it granted? Yes No Is the organization a member of any parent organization, provincial associations, or national associations? If yes, specify which ones: CONTACT PERSON & TELEPONE #: Does your organization have a Board of Directors? YES NO (If yes, complete the following chart) POSITION MEMBER * Please indicate if position is vacant Page 3 of 14 CERTIFICATION BY THE BOARD OF DIRECTORS This is to certify that the attached budget and the accompanying documentation is an accurate statement of our receipts and disbursements, both actual and estimated, for all the activities conducted by the organization, that the amount requested is necessary for proper continuance of our program, and that the attached application has been filled out truthfully and the answers reflect the activity of the organization Signed: Title: Date: Phone: Is your organization incorporated? YES NO Provide organizational char and minutes of general meeting. PROGRAM/ACTIVITY INFORMATION Describe the ORGANIZATION in general: Does your application meet the city of Hamilton’s strategic plan vision, mission, values and goals as developed by City Council www.hamilton.ca/m_v_v.asp ? Please check which are applicable: A City of Growth and Opportunity A Great City to Live In A Healthy, Safe and Green City A City Where People Come First A City that Spends Wisely and Invests Strategically A High Performance Workforce Please provide a brief description of the program or initiative that your group is applying for that will answer the who, what, where, when and how. Page 4 of 14 Is there a demonstrated need for the program/initiative and do you have support documentation? Will all members of your organization be eligible to participate in the program or is the activity geared to one specific group? Please explain. How will the program for which you are requesting City funding address the objective(s) you identified above? Be as specific as possible. How does the program for which you are requesting City funding consistent with the goals and strategies of Vision 2020: The Sustainable Community www.vision2020.hamilton.ca ? Page 5 of 14 Do any private sector organizations provide similar services? YES NO If yes, explain why a non-profit approach is necessary or desirable: Page 6 of 14 Are other organizations in the City providing a similar program? Yes No If yes, please list them: What is the purpose of the program/activity or what do you hope to accomplish? Does any program co-ordination take place between any of the organizations listed above? Yes No If yes, please describe any joint projects below. If no, explain what steps your organization takes to ensure no duplication of services exists within the community. How many volunteers will be used to deliver this specific program? # or None How many volunteer hours will be contributed to this program on annual basis? Hours How will your participants benefit from your program? Please provide examples on how does the program for which you are requesting City funding ensure accessibility for persons with disabilities? Page 7 of 14 Please provide examples on how does the program for which you are requesting City funding ensure accessibility for persons from diverse ethnic & cultural groups? PROGRAM/ACTIVITY STATISTICS 2008 2009 2010 2011 YTD # OF PARTICIPANTS # OF PARTICIPANTS # OF PARTICIPANTS # OF PROJECTED Page 8 of 14 PROGRAM/ACTIVITY EVALUATION by Organization How will the program be evaluated to ensure that it is meeting the goals and objectives for the program identified on? Be as specific as possible. How often is the program evaluated on an annual basis? (Be as specific as possible) Identify the key outcomes for this program? Are participant satisfaction surveys used? Yes No How often? # /Year Please provide a sample survey and results. Page 9 of 14 FINANCIAL INFORMATION Submit the most recent annual financial statements with this application (along with accountant's comments/opinion) Please list any programs delivered by your organization which are funded whole or in part by any department of the city of Hamilton Program Name City Department Contact Name Contact Information Will conditional funding be refused if City assistance is not received? YES NO (If yes, please list source, address, and contact person). Please explain any unusual increases or decreases in expenses/revenues. How often is financial information reviewed for this program and by whom? Please describe in detail. Please identify any specific financial control methods used by the organization to maintain the integrity of the finances of the organization. Page 10 of 14 Please provide a financial forecast of the yearly Community Partnership Program requests anticipated over the next one to five years (if appropriate). What steps has your organization taken to reduce costs or to find alternative sources of funding? List activities that your organization conducts to raise additional funds. In the current year, how much net revenue was generated from these activities? $__________ What % of this program’s budget will be generated through fundraising? $____________ Page 11 of 14 PLEASE COMPLETE FOLLOWING SCHEDULES: EXPENSES 2010 OPERATING 2010 ACTUAL 2011 BUDGET SALARY Management staff Other wages Employee benefits STAFF Travel/meetings Staff development Volunteer expenses Other expenses SERVICE/PROGRAM Assistance to participants Program supplies Other expenses Dues to parent organization Insurance Professional, legal Office supplies Other administrative PROMOTION & PUBLICITY Supplies & services Advertising FACILITY EXPENSES Rent(paid to landlord) Property taxes Utilities EQUIP. & FIXED ASSETS Equipment rentals/mtce Provision for replacement OTHER TOTAL EXPENSES Page 12 of 14 2010 OPERAT. 2010 ACTUAL 2011 BUDGET REVENUES GENERATED REVENUE Designated donations Unrestricted donations Membership fees Fees for service Fundraising United Way funding Other revenue SUB-TOTAL GOVERNMENT FUNDING City Community Partnership Program request Other Municipal governments Provincial government Federal government Trillium Foundation SUB-TOTAL TOTAL REVENUE SURPLUS(DEFICIT) End of prior year Current year Plus transfers from capital Less transfers to capital Less surplus returned ACCUMULATED SURPLUS/(DEFICIT) Page 13 of 14 ADDITIONAL FINANCIAL INFORMATION Is the participant charged a fee for this program? Yes Amount? No How is the fee determined? What % of the costs does the fee cover? Attach program fee schedule if available. Please identify what would be the impact on your program if your funding request was not granted or reduced. Be as specific as possible. Would the impact result in a loss or reduction of service? Would the program still be viable? Would the program cease? Of the funds identified on your organization's balance sheet are there any amounts which are restricted in their use? Yes No If yes, specify the amount and nature of these restricted funds: Page 14 of 14