Quality of Life Grant Application Form

Name and Contact Information

Applicant Organization’s Legal Name

Address to use for correspondence:

Contact Name (person responsible for filling out application), Phone # and E-mail

Name

Email

Phone

Executive Officers (up to 4 names)

Officer 1

Name and Title

Email

Phone

Home Address

Business Address

Officer 2

Name and Title

Email

Phone

Home Address

Business Address

Officer 3

Name and Title

Email

Phone

Home Address

Business Address

Officer 4

Name and Title

Email

Phone

Home Address

Business Address

Grant Request & History with City of Moncton

How much are your requesting from the City in this application?

Is this operational or for a specific project?

Operational

Project

Has your organization received funding assistance from the City of Moncton in the past?

Yes

No

If yes, please fill out the following table:

Re-order	Funding Program	Requested $	Awarded $	Weight	Operations
	Funding Program	Requested $	Awarded $	Item weight

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About Your Organization

Which of the following categories apply to your organization? (please click all that apply)

Registered charity

Non-Profit Organization

Athletic/Sports

Cultural

Environmental

Educational

Other

Sector

Date of incorporation

Incorporation #

Charitable tax #

Please provide the number of paid staff, volunteers and members your organization employs/utilizes.

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?

No

Yes (please explain)

For first time applicants only – In a few lines, briefly describe what types of services or programs your organization provides:

What type of collaboration/partnership does your organization have with other organizations, agencies and groups in the community? List as many as possible:

Re-order	Partner	Collaboration details	Weight	Operations
	Partner	Collaboration details	Item weight

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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 2020 work program would help to address the goals of the City of Moncton

http://www5.moncton.ca/docs/council/Strategic_Plan_2016-2020.pdf

Financial Information

Organizational Funding Structure

From whom and to what amount has your organization obtained funding ($)?

Please provide any other relevant information here:

Required Attachments

Please ensure you have included any and all of the following document that apply to you grant application.

Please attach your financial statements for the current year, as well as financial statements (reviewed/audited) from an external accounting firm for the previous three years. Maximum upload size is 50 MB.

One file only.
50 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

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.

One file only.
50 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Please provide the progress report for the previous year. Applications will not be considered unless this is received.

One file only.
50 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.