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Community Investment Grant Application Form

Complete this form and attach all required information to apply for a Community Investment Grant.

Please note: applications will not be accepted if Accountability Statements from previous grants have not been received.

Organization Name:

Contact Name:

Mailing Address:

Postal Code

Phone No.

Email address:

Name and Contact Information for Executive Members

Requested Amount (not to exceed to $5,000)

Describe the purpose of your proposed project and indicate what municipal funding will be used for if approved.

How will your project benefit the Municipality of Kincardine?

Provide a list of other funding sources for your organization.

Describe your organizations methods of solicting support from the community and what response was received.

Describe the efforts of your organization to match the funds requested from the Municipality.

Explain how your organization will sustain the project in the future.

ENCLOSE THE FOLLOWING INFORMATION:

Budget for the current year

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Financial reports for last year

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Confirmation of Not for Profit Status

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_{*Sports/Recreation applicants must provide facility costs and enrollment numbers of their particular groups}

INFORMATION TO BE PROVIDED IF FUNDING IS APPROVED:

Financial reports for the year the project is completed
Accountability report describing the use of municpal funds and outcomes achieved.

ATTACH ANY ADDITIONAL INFORMATION WHICH YOU FEEL MAY ASSIST IN EVALUATING YOUR APPLICATION (PLEASE LIMIT THE VOLUME OF INFORMATION)

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I have read the eligibility criteria and confirm that the organization will comply with all requirements.

Authorized Signature (use your mouse or touchpad to sign in the box below)

Clear

Date

Personal information is collected under the authority of the Municipal Act, 2001, S.O. 2001 for the purpose of creating a record to determine eligibility for a Municipal Community Investment Grant. Questions about this collection should be directed to the Clerk of the Municipality of Kincardine at 1475 Concession 5, RR #5, Kincardine ON N2Z 2X6 or by phone at (519) 396-3468