Quality of Life Grant Application Form Please note that the following types of organizations are not eligible to apply for this grant category: Non-City of Moncton resident; 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 predominantly outside of the City. 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 Yes No No If yes, please fill out the following table: Re-order Funding Program Requested $ Awarded $ Weight Operations Funding Program Requested $ Awarded $ Item weight Add more items more items About Your Organization Which of the following categories apply to your organization? (please click all that apply) Registered charity Registered charity Non-Profit Organization Non-Profit Organization Athletic/Sports Athletic/Sports Cultural Cultural Environmental Environmental Social Social Educational Educational Other 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 Yes No No If “No”, do you offer services in Moncton? Yes Yes No No Is your organization a branch of a provincial, regional or national organization? No No Yes (please explain) Yes (please explain) Enter other… 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 Add more items more items 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 This is a new initiative / We would like to enhance an existing initiative/service Maintain existing level of service or programming 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 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: 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. 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: 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. 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: 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.