City of Toronto Identify ’N Impact Investment Fund Application Form Deadline: Tuesday, June 9, 2009 No later than 4pm. See next page for submission options. Fax applications are not accepted. Social Development, Finance and Administration INIfund@toronto.ca 416-392-9125 Application deadline: June 9th, 2009—no later than 4pm. Hand deliver or mail to: INI Investment Fund Social Development, Finance and Administration 100 Queen Street West 15th Floor, East Tower Toronto M5H 2N2 (If by mail, must be postmarked by June 9th 2009) Or e-mail to: INIfund@toronto.ca If you send your application by e-mail, please send an original signature (question 9) in the mail. If you are applying with a trustee, please also send an original signature (question 19) of the Trustee Information form in the mail. We do not accept Fax applications. For more information, contact the Community Resources Section 416-392-9125. City of Toronto CPIP 2009 PART B: Project Assessment Page ___ Organization name: _________________________________________________________ Project Name: ______________________________________________________________ Directions for completing the application The INI application package includes: Guidelines – Read this first Policy Documents – What you need to know about city funding policies Trustee Information-- Use this section if you are applying with a trustee Application Form – Complete questions 1-10 and the Declaration of Non Discrimination The Application Form has three parts that every applicant needs to submit. 1) Questions 1-10 in this document, 2) a Workplan document (Question 4) 3) Declaration of Non-Discrimination (to be printed and signed) Answer each question clearly, completely and concisely. The application form is in Word format. There are page breaks between some of the questions: if you need to see where they are use Normal view. If you are getting odd formatting or lots of white space, you can adjust the page breaks. Question 6 is the budget income and expenditure information. There are no formulas in this table: please make sure your numbers are added up correctly. When you submit your request, submit one copy of the complete paper version of the application, including original signatures. Use the checklist (Question 8) to make sure you have submitted all the required attachments. If you send your application by e-mail, please send an original signature (question 9) in the mail. If you are applying with a trustee, please also send an original signature (question 19) of the Trustee Information form in the mail. Keep a complete copy of the application for your records. Do not send us your application by fax, or on diskette or CD. Disclosure of Information: The information provided in your application is subject to the provisions of the Municipal Freedom of Information and Protection of Privacy Act. All granting decisions are publicly available. City of Toronto CPIP 2009 PART B: Project Assessment Page ___ Organization name: _________________________________________________________ Project Name: ______________________________________________________________ 1. Applicant Contact Information Group or organization name: Mailing Address: Postal Code: Telephone: Fax: Email: Website: Primary contact person Title or position: Phone number: E-mail: Secondary contact person Title or position: Phone number: E-mail: The personal information on this form is collected under the authority of the City of Toronto Act , 2006, s. 83(1) and 136(c), and By-law No. 600-2006. The information is used to process your application for the Identify N Impact Investment Fund and for aggregate statistical reporting, and will be shared with volunteer youth panel members for the purpose of making funding recommendations. Questions about this collection can be directed to Program Support Analyst, 15th Floor, East Tower, City Hall, 100 Queen Street West, Toronto, ON M5H 2N2. Telephone: 416-392-9125 City of Toronto CPIP 2009 PART B: Project Assessment Page ___ Organization name: _________________________________________________________ Project Name: ______________________________________________________________ 2. Applicant Information: 2a) Tell us about your organization. You can use these questions as a guide. When and why did the organization/group start? What are your goals? What are your main activities? What are you known for in the community? What are your accomplishments over the past year? Who can be a member of your group? How many members do you have? How do you recruit new members? How does your group operate? How are decisions made? 2b) What resources have you used for your activities? (Space, food, equipment, publicity, etc.) Who provides these resources? Does your group receive funding for any of its activities? If yes, who are the funders? 2c) Are you incorporated? Yes No If you are incorporated, attach a copy of your letters patent to your application. 2d) If you are not incorporated, you will need to develop an agreement with a trustee in order to receive funding. Do you have a trustee? Yes No If you have a trustee, please complete the trustee information included in the package. 3. Project Information: check the Guidelines for information on how project ideas will be reviewed. Make sure to include information about which priority neighbourhood you are working in and/or how your project engages racialized youth, particularly African Canadian youth. If you have multi-media material that demonstrates aspects of your project or your group’s skills, you may send it with your application. City of Toronto CPIP 2009 PART B: Project Assessment Page ___ Organization name: _________________________________________________________ Project Name: ______________________________________________________________ What is your project IDEA? What do you want to accomplish? How will your project make your community better? What will change for youth and for your community as a result of this project? How will more youth in the community get involved? How old are the youth involved in this project? How is this project youth-led? How will the project increase youth leadership skills and opportunities? Will your project address any of these priorities? – Check ONLY one that best describes your project. Youth led activities Work with youth to develop youth leadership and create opportunities for decision making Focus on racialized youth/African Canadian youth Other (please specify) : ________________________________________ __________________________________________________________ City of Toronto 2009 Identify ‘N Impact Investment Fund INI gives priority to projects working in the 13 identified priority neighbourhoods, will your project serve any of these priority neighbourhood areas? Crescent Town Dorset Park Eglinton East-Kennedy Park Flemingdon Park-Victoria Village Jamestown Jane/Finch Kingston/Galloway Lawrence Heights Malvern Scarborough Village Steeles-L’Amoureaux Westminster-Branson Weston-Mt.Dennis City-wide No, none of the above 4. Project workplan: Please fill out the workplan form. It is included as a separate document in your package. 5. Financial information How much money did your group spend in the past year? $_____________________ What resources are available in your community to help you with your INI proposed activities? Use this table to tell us about contributions other than money, such as space, supplies or services. Add more rows if you need them Type of support Source Estimated Value Example: Space Shopping Mall $2,000 City of Toronto 2009 Identify ‘N Impact Investment Fund 6. Budget: Income and Expenditure plan Project time period PROJECT INCOME From____________To_____________ Identity ‗n Impact request Other grant funding (if applicable) Where will this come from? Is it already approved? Donations Fundraising Other income (for example: product sales) TOTAL PROJECT INCOME PROJECT EXPENDITURES Salaries What positions? What hourly rate? Employee Benefits Staff Training Staff Travel Building Occupancy (rent: regular meeting space, program space, special event locations etc.) Office Expenses Equipment Volunteer Expenses Transportation (volunteers + participants) Promotion & Publicity Purchased Services (translation, printing, other) City of Toronto 2009 Identify ‘N Impact Investment Fund Childcare Costs Program Expenses Administrative Costs (maximum 20%) What will be covered? Other Expenditures Please describe what these are. TOTAL PROJECT EXPENDITURES PROJECT SURPLUS or (DEFICIT) Your project should end up at ―0‖—no surplus or deficit For details, please refer to Appendix 1, Account Charts Notes 7. Community Links and Support Please tell us about your experience and involvement in the proposed community. What other partner organizations or groups will you work with to implement this project? Please provide the name of the group, their contact number and information on how you plan to work with them. 8. Attachments checklist Information to submit with your application Check list: Yes, No, Notes 8a) If you are incorporated, please send a copy of the Letters Patent that established the organization. Please send a copy of your organization by-laws if you have them. 8b) Declaration of Non-Discrimination. Please sign and return the Declaration form. If your group or organization has a budget larger than $25,000, we will ask you for an access and equity policy, complaints process and implementation plan if you are recommended for funding. 8c) Recent audited financial statement. If your organization or group has a recent audited financial statement, please provide a copy. If you do not have an audit, we will ask you to work with a trustee if you are recommended for funding. 8d) If you have multi-media material that demonstrates aspects of your project or what you have already accomplished as a group, you may include it with your application. 8e) Are you applying with a trustee? Ask the trustee to submit the Trustee Information form. City of Toronto 2009 Identify ‘N Impact Investment Fund 9. 2009 Identify ‘N Impact Investment Fund—Application authorization The organization I represent is applying for funding under the 2009 Identify ‗N Impact Investment Fund (INI) to support the project (name) _______________________________________ for the amount of $_________________. To the best of my knowledge, information in this application is accurate and complete. This funding request is endorsed by the organization I represent. If funding is granted by the City of Toronto from the Identify ‗N Impact Investment Fund, the Board of Directors or Governing Body agrees to the terms and conditions outlined in the application package. This application was approved by the Board of Directors, the Executive or the Governing Body at its meeting on _____________________________________________________, 2009. _________________________________ _______________________________ Signature Date Signed _________________________________ Name & Title (please print) City of Toronto 2009 Identify ‘N Impact Investment Fund 10. List of Board or Committee members Please provide a list of the people responsible for your organization: If you are incorporated, this will be your board members. If you are not incorporated, list the members of your committee or other body that is leading the activities. As part of the eligibility criteria for City of Toronto Grants, organizations must be based in the City of Toronto. One indicator is that 50% or more of your Board members or governing body members live in the City of Toronto. Committee or Board member’s Postal code Position Date they Total Name (for example: became a number of Chairperson, member of the years on the Treasurer etc.) current committee committee or or Board Board The personal information on this form is collected under the authority of the City of Toronto Act, 2006, s. 83(1) and 136(c), and By-law No 600-2006. The information is used to verify residence. Questions about this collection can be directed to Program Support Analyst, Community Partnership and Investment Program, 15th Floor, East Tower, 100 Queen Street West, Toronto, ON, M5H 2N2. Telephone: 416-392-9125.
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