Walmart Evergreen Form 2011EN by FgAD7k

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									Walmart–Evergreen
Green Grants
2011 Application
This application consists of 3 parts:

Part A consists of general questions about your organization and project.
Part B asks for information on your budget and fundraising efforts.
Part C is a checklist of required attachments to include with your application.

For Parts A and B, please:

•   save as a new document and type your responses
•   do not exceed the specified word limits
•   number each page; and
•   answer every question


PART A – General Information
About Your Organization

1.    Name of Organization:
      Name of Contact Person:
      Full Address:
      Telephone:
      Fax:
      E-mail:
      Website:
      Alternate contact name:
      Alternate email address:

2. Is your organization legally incorporated? If not, please state which institutional
partner would be responsible for administering funds.


3. Please tell us about your organization. What is its mandate/mission? When was it
established? Describe the community it serves/represents. (maximum 100 words)


4. Describe your organization’s past experience planning and carrying out ecological
restoration or community gardening projects. (maximum 200 words)


About Your Project

5. Project Name:

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6. Total amount of support requested from the Walmart–Evergreen Green Grant
program: $

7. Are you proposing to plant trees and/or shrubs as part of this project?

If so, how many trees and/or shrubs will be planted in 2011?


8. Where is it located (please indicate the municipality, region, and site in which the
project will be developed)?


9. Please provide a concise description of your project (maximum 200 words) with
reference to:
• why it is important
• the issues/problems that it is addressing in your community
• what makes it unique.


10. More specifically, what are the primary three goals of your project? What tasks
will be undertaken to accomplish them? When is each task expected to begin and
end? Please provide your answers in a table as shown below:

Goal                  Tasks to Achieve      Expected Start        Expected
                      Goal                  Date                  Completion Date




11. When is the project expected to begin and end (month/year)?


12. Have you applied for an Evergreen Grant in the past?
 If no, please proceed to Question 14. If yes, please answer the following question.

13. Was your application successful?


14. Describe your site (maximum 150 words) and provide a sketch-plan (hand-
drawn is acceptable) making specific reference to:
• its natural and built features
• access (example: street, pathway, service road etc.)
• its location in a built-up or remote part of town
• how it is currently used by the community
• natural and built features on the surrounding properties




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15. Which public agency or institution owns the land? Please attach a letter of
permission from the landowner. Please remember that projects that are not publicly
accessible are not eligible.


About Your Partners

16. Who is your institutional partner? Please describe their role. (For an
explanation, please see “Who Can Apply?” section of the Grant Application Guide.)


17. Do you have other project partners? If so, please list them and briefly describe
their role. (maximum 50 words)


Community Involvement and Outreach

18. What types of volunteer opportunities will your project create? Please describe
the activities that are planned (maximum 100 words)


19. How will you promote the project to attract volunteers? Please describe your
outreach plans, as well as any activities you have undertaken to date. (maximum
100 words)


20. How will you raise awareness in your community about the project? Please
describe any promotion, outreach and/or funder-recognition activities you have
planned, or that you have undertaken to date. (maximum 100 words)


21. How will you ensure that the project is maintained and cared for over the
long-term, including weeding, site cleanup, addressing vandalism etc? (maximum
200 words) Please indicate who will be responsible for the on-going care of the site
and what they will do.


Permits, Approvals and Potential Impacts
22. Identify the federal, provincial and/or municipal agency approvals that your
project requires. Please describe the steps you have taken to obtain them.
(maximum 100 words) Attach any approvals already received and indicate any that
are pending.


23. Please explain how you will address negative environmental impacts that may
result from your project (e.g., soil erosion, sedimentation, etc.) and/or how your
project will reduce negative environmental impacts on the local environment.
(maximum 100 words)


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PART B – Budget
Remember that the Walmart—Evergreen Green Grant can cover up to 50% of total
project costs, and that some types of expenses are not eligible to be covered by the
grant. Up to 20% of the total grant funds may be used for staff wages, salaries and
professional fees. Please review the Grant Application Guide for more information.

Project Revenues

24. In table format (using the template shown below) please list all confirmed
sources of financial and in-kind support, including (as “pending”) requested funds
from the Walmart—Evergreen Green Grants program.(In-kind donations are all
non-cash contributions to your project including supplies, services and equipment
and volunteer labour.)

Revenue: Sources of Funds for Proposed Project
The following template shows common categories of revenue, please use extra lines
if needed.
      Revenue          Confirmed   Pending Cash   Confirmed In-   Pending In-   Total
                         Cash                         Kind           Kind
Government Grants
Federal
Provincial
Municipal
Government Subtotal
Fundraising
Individuals
Corporations
Foundations
Other (list)
Fundraising Subtotal




Earned Income
Other (list)
Earned Income
Subtotal
Current Assets
Current Assets
Subtotal




Total Project
Revenue




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Project Expenditures

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     a) If you are including salary / wages in your Project Expenditures table, please
        indicate which position(s) they will fund, and how the position(s) will
        contribute to the project’s goals. (maximum 50 words)


     b) In table format (using the template shown below) list all the expenses that
        you are expecting to incur. Please indicate the expenses that the Walmart–
        Evergreen grant will pay for, should your project be awarded funding.

Expenses: Project Related Expenses
The following template shows common categories of Revenue, please use extra
lines if needed. * Please include the value of all in-kind donations
EXPENSES                       Evergreen Funding   Other Sources*    Total
Human Resources (Maximum
20% of awarded funds)
Salaries/Wages
Professional Fees (i.e.,
consulting)




Project Expenses
Native Plant Materials
Gardening Tools & Supplies
Transportation




Communications/Promotions
Printed materials
Community Outreach




Other (list)
Volunteer Support/Honouraria
Health & Safety Supplies




Total Project Expenses




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PART C - Attachments Checklist
ALL APPLICANTS MUST INCLUDE:

• Street map showing the location of the project in your community
• Letter(s) from institutional partner(s)
• Letters of approval (or support in principle, specifying outstanding requirements to
obtain full approval) from regulatory agencies
• Letter of permission from the landowner(s), verifying that the land is publicly
accessible (If the landowner is the institutional partner, one letter can be submitted
stating partnership and accessibility of the site).
• A sketch-plan of the site showing existing built and natural features, location of the
work site, access points and a north arrow
• List of all species of plants, trees, shrubs and wildflowers that you intend to plant,
including totals. (Please note that this grant only covers native species. A list of plants
native to your province is available on Evergreen’s Website at
http://nativeplants.evergreen.ca/)

Applications must be submitted by mail or courier and in our office no later
than January 31, 2011.
Faxed and emailed applications will not be accepted. Send your application package to:

                            Walmart–Evergreen Green Grants
                        Evergreen Brick Works, 550 Bayview Ave.
                           Centre for Green Cities, Suite 300
                               Toronto, Ontario M4W 3X8

If possible, please consider double-sided printing, and limiting your use of non-recycled
materials.

For more information please contact:
Alix Aylen, Grant Program Administrator
Phone: 416-596-1495 x312
Toll free outside Toronto: 1-888-426-3138 x312
Fax: 416-596-1443
E-mail: aaylen@evergreen.ca
evergreen.ca

Each year, Evergreen receives more eligible applications than we are able to fund.
While we would like to support all eligible projects, please note that we do not have
sufficient funds to do so.

              We will respond to all applicants by March 31, 2011.




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