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					                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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