Grant Application Form

Please review the Grant Application Policy prior to submission. Download the printable PDF form.

Applicant Information

Organization Name *

Contact Name and Position *

Organization Mailing Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Website

Telephone Number *

With extension (if applicable)

Email Address *

Questionnaire

Grant Amount Applied For *

Organization's goals and objectives related to the grant request *

Briefly describe the proposed event, project or service that will be funded by this grant. Please ensure that items identified as not eligible for funding under Section 3.0 of the Grant Application Policy are not listed. *

Please provide a narrative description explaining how the Township's approval of grant funding would enable your organization to sustain or provide additional support to the community. *

If your organization is unsuccessful in receiving a Township grant, what will be the effect on the proposed event, service, or project? *

Choose one category of funds requested

Category 1: Donation (funds requested - less than $500)
Category 2: Sponsor or contributor (funds requested - $500 to $3000)
Category 3: Project funder (funds requested - greater than $3000)

Please provide a copy of the most current budget *

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of the most current financial statements *

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide the annual reporting requirements in accordance with Section 8 of the Township Grant Application Policy if your organization was a successful applicant in a previous year (mandatory for previous funds received of greater than $3000) *

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Submission of the following three items is required for the initial application only

Please provide a copy of letters patent or articles of incorporation, if applicable

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of Notification of Charitable Registration letter from the Canada Revenue Agency with any supporting documentation indicating the applicant's status and terms of registration, if applicable

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Please provide a copy of mandate, constitution and by-laws, as applicable

Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Terms and Conditions

The above application and supporting documents attached will be used for the assessment of eligibility and for Township reporting purposes. The applicant will inform the Township if the project is delayed or changed substantially for any reason. Funds received are to be used as described in this application. All applicable municipal by-laws, policies and procedures will be adhered to.

I/we agree to the terms and conditions outlined above. I/we have reviewed the Grant Application Policy. The information given in support of this application is true, correct and complete in every respect. I/we acknowledge that the contents of this application will be discussed in an open Council forum. I/we declare that the organization listed in the application is in good standing with the Township and other government bodies.

Dated This Day *

Name and Office/Position: I/We have authority to bind the Corporation/Organization *

Signature of Applicant on behalf of Organization *

Name and Office/Position: I/We have authority to bind the Corporation/Organization

Signature of Applicant on behalf of Organization

The last day for filing an application is by 2:00 pm on the last business day of August of the current fiscal year.

Personal information on this form is collected under the authority of the Municipal Act and will be used for the purpose of determining the eligibility of a grant. The information is used for the purpose of processing the application and administering the Grant Application Program and is maintained in accordance with the Municipal Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information may be directed to the Township Clerk's office.

The Township of Puslinch is committed to providing accessible formats and communication supports for people with a disability. If another format would work better for you, please contact the Township Clerk's office for assistance.

Name