Application for Financial Assistance from the Lions Club of Raglan
I. Applicants should appreciate that the Lions Club of Raglan receives numerous applications for financial assistance. By completing this Application form you will assist the Club in making its decision, which we trust will be of benefit to you/your organisation.
2. The applicant a representative of the organisation may be requested to answer any queries by a member or to make a personal submission before or to address a meeting of the Committee.
Part A
Name of Applicant or Organisation: .................
Postal Address: ............................................................................
Contact person: ..................................... Contact Phone Number:... ... ... ... ... ...
What is your project and why do you need financial assistance from the Lions Club of Raglan?
Project start date _____________________ Expected Finish date______________________
Where will it take place and how will it be of benefit to the community of Raglan?
What feedback have you received from interested parties regarding your plans?
(i.e. why are you undertaking the project – members’ comments, community requests etc)
Part B
|
Please list all details below inclusive of GST Project Costs – List all associated costs
|
$ |
Income - How is finance made up? |
$ |
|
Total Cost of Project (A) |
Total Income (B) |
||
How much money are you applying for? $__________ If there is a shortfall (i.e. you receive less than this request) how will you meet this?
___________________________________________________________________________
Has any funding been spent on this project to date?__
Briefly describe any voluntary effort or donated material provided towards the project
3. If successful in receiving financial assistance from the Lions Club of Raglan, the applicant or a representative of the organisation will be invited, after the completion of the project or event, to attend one of the Club's monthly meetings and give a short (3-5 minute) address outlining the outcomes, experience and benefits gained.
Part C
Have you made any other applications for funding for your project which have not yet been considered?
- Organisations
- Amount requested
4. All decisions of the Lions Club of Raglan in respect of any application shall be final and no appeal against any decision will be considered.
Declaration
I hereby declare that the information supplied here on behalf of our organisation is correct. We understand that the information supplied in this application may become public information. We consent to the Lions Club of Raglan holding the personal contact details provided in the application and using these details. This consent is given in accordance with the Privacy Act 1993.
Name_______________________________________________________________
Position in Organisation__________________________________________________________
Signature____________________________________ Date____________________
Application’s should be clearly marked on the envelope “Funding Application” and sent to the address below or can be personally delivered to the Raglan Book and Gift Shop.
Lions Club Raglan
PO BOX 180
Raglan 3225
Email bobmacleod@paradise.net.nz
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