Team Scotia Community Program Application Form Part 1

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					                                  Team Scotia Community Program Application Form
                                       Part 1 – Initial Employee/Team Request


Instructions

1. Type in details or print form and fill in manually
2. Forward to Scotiabank Bright Future Champion for Approval
3. Submit one application per Organization/ Charity, per event
                                                                                                                           DATE (YYYY/MM/DD)


To:
 SCOTIABANK BRIGHT FUTURE CHAMPION/ COUNTRY HEAD




From:
 BRANCH                                                                                        COUNTRY                            TRANSIT


 EMPLOYEE/ TEAM LEADER                                                                         TELEPHONE                          FAX




Event Description (How did the Scotiabankers raise the funds)




Name and Address of Organization/ Charity (Please complete one application per charity)
 COMPLETE NAME


 ADDRESS                                                                    CITY/COUNTRY                                          POSTAL CODE



 CHARTIBLE REGISTRATION NUMBER (IF APPLICABLE)                                                             ESTIMATED AMOUNT TO BE RAISED



 USE OF REQUESTED FUNDING



 IF SCOTIABANK HAS FUNDED THIS CHARITY IN OTHER WAYS, PLEASE DESCRIBE AND ADVISE THE AMOUNT




Volunteers
 VOLUNTEER PARTICIPANTS (TOTAL NUMBER)


 NAME                          BRANCH                                                         COUNTRY                                   TRANSIT

 NAME                          BRANCH                                                         COUNTRY                                   TRANSIT


 NAME                          BRANCH                                                         COUNTRY                                   TRANSIT


 NAME                          BRANCH                                                         COUNTRY                                   TRANSIT




Recommendation (include benefits received by Scotiabank involvement)




Team Leader Initial   __________________                   OR        Scotiabank Bright Future Champion Country Head Approval__________________

4645413 (08/07)
                                     Team Scotia Community Program Application Form
                                              Part 2 – Approval/Decline Form



Instructions

Scotiabank Bright Future Champion or Country Head must approve or decline Employee/Team request using form.

1. Type in details or print form and fill in manually
2. Sign form and return to the Team Leader

 EMPLOYEE/TEAM LEADER (50 characters maximum)                                                                   DATE (yyyy/mm/dd)


 STATUS
     Approval
     Decline – Scotiabank Bright Future Champion/Country Head to forward decline memorandum to Employee/Team Leader



COMMENTS (optional)




 SCOTIABANK BRIGHT FUTURE CHAMPION/OR COUNTRY HEAD SIGNATURE            COUNTRY




4634111 (08/07)
                                                           Team Scotia Community Program
                                                               Part 3 – Event Follow-up



Instructions

1. Type in details or print form and fill in manually

To: Scotiabank Bright Future Champion/ Country Head
 NAME (50 characters maximum)                                                         CHAMPION COUNTRY                       DATE (yyyy/mm/dd)


 ACTUAL AMOUNT RAISED BY SCOTIABANK (Team members only)
 $
 TOTAL AMOUNT RAISED BY ENTIRE EVENT (ie. by all participants)
 $
 NUMBER OF SCOTIABANK PARTICIPANTS                                            NUMBER OF HOURS VOLUNTEERED BY SCOTIABANKERS




Comments (optional)




 Scotiabank Bright Future Champion/ Country Head confirms amount of funds raised              Initials ______________________


 Once the event is completed, forward all forms – (Parts 1, 2 and 3) for reimbursement of the matched portion of funds to:

 Donations/Sponsorships/Special Events
 40 King Street West
   rd
 63 Floor, Transit No. 93468
 Toronto, Ontario

 Attention:
 Janet Slasor
 Tel: (416) 866-4293
 Fax: 416-866-5705
 e-mail: janet_slasor@scotiacapital.com




4645715(08/07)