Cultural Grant Application Form Please note that the following types of organizations are not eligible to apply for this grant category: Non-City of Moncton organizations; Government agencies; For-profit groups; Groups aligned with any political party or to support programs or services thereof; Groups aligned with any religious affiliation, or to support programs or services thereof; Individuals; Commercial ventures; and Groups using the funds to operate the program, project or operation outside of the City. Name and Contact Information NAME AND CONTACT INFORMATION Name Email Phone Address City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Country - None -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Grant Request & History with City of Moncton How much are you requesting from the City in this application? Is this operational or for a specific project? Operational Project Did your organization receive funding assistance from the City of Moncton last year? Yes No if yes, please fill out the following table: Tell us about the funding program and amount awarded About Your Organization Which of the following categories apply to your organization? Sector Registered charity Registered charity Non-Profit Organization Non-Profit Organization Public Post-Secondary Public Post-Secondary Type of Organization Athletic/Sports Athletic/Sports Cultural Cultural Environmental Environmental Social Social Educational Educational Settlement Services Settlement Services Other Other Date of Incorporation Incorporation # Charitable Tax # Please Provide the number of Paid Staff, Volunteers and Members your Organization employees/utilizes below. Is your organization based in Moncton? Yes No If “No”, do you offer services in Moncton? Yes No Is your organization a branch of a provincial, regional or national organization? Yes No If "Yes", please explain If your organization is a new organization, or grant applicant, briefly describe what types of services or programs your organization provide? What type of collaboration/partnership does your organization have with other organizations, agencies and groups in the community? List as many as possible: PURPOSE OF GRANT FUND REQUEST Why are grant funds being requested? What would the funds be used for? Is this a new initiative for your organization, are grant funds being requested to enhance an existing initiative, or will funding be used to maintain existing level of service or programming? This is a new initiative / We would like to enhance an existing initiative/service Maintain existing level of service or programming What outcomes are your organization aiming to achieve and how will it directly benefit the citizens of Moncton or the development of the municipality? Please describe how your 2021 work program would help to address the goals of the City of Moncton Cultural Strategy. (Refer to pages 24-32 of the 2016-2026 City of Moncton Cultural Plan) http://www.moncton.ca/Assets/Government+English/Publications+English/Moncton+Cultural +Plan.pdf EXECUTIVE OFFICERS Please provide up to 4 names with title, phone number and email Please provide any other relevant information here: Required Attachments Checklist Please ensure you have included any and all of the following document that apply to you grant application: Please attach your financial statements or reports for the current year. Maximum upload size is 50 MB. Please attach your full project-initiative budget, including a breakdown of all confirmed and proposed sources of funding for the initiative. Maximum upload size is 50 MB. (template provided upon request) Please provide the progress report for the previous year. Applications will not be considered unless this is received. Financial statements or report One file only.64 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Project-initiative budget One file only.64 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Progress report for the previous year One file only.64 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.