number of Total number of clients/members who live clients/members in Napier What percentage of your project / % service will be delivered in Napier? How often is your project / service Choose one from below: delivered in Napier Weekly Monthly Adhoc (when Number of Number of Full time needed) days per days per week: month: Budget COSTS FOR NAPIER DELIVERY ONLY – List all the for the project or service proposed. Include costs that your organisation or others are funding (this may be a of a cost item) . List the costs that your are seeking funding from Napier City Council ‘share’ FIRST. (see example at the end of this form) Item Cost Amount of Amount from other funding contributors e.g. own requested from organisation/other Napier City funder/sponsorship/user Council fees etc A: Total B: Total C: Other Contributions Please list all the other funders you have applied to for funding for this project or service Funder Amount Requested Outcome (Approved, declined or enter the date the outcome will be known) Total Funding Requested (Total $ Request Total Funding Amount requested (Total D from Total amount requested from NCC (Total B from Q 8 Q 9 - GST exclusive) above) $ $ Is your organisation, and/or staff, required to meet external accreditation/audit requirements in order to provide its services? (eg CYFS acreditation, industry registration etc) No go to question 12 Yes what accreditation or audit requirements apply? Please List: – –
number of clients/members Total number of clients/members who live in Napier What percentage of your project / service will be delivered in Napier? % How often is your project / service delivered in Napier Choose one from below: Full time Weekly Number of days per week: Monthly Number of days per month: Adhoc (when needed) Budget – COSTS FOR NAPIER DELIVERY ONLY List all the for the project or service proposed. Include costs that your organisation or others are funding (this may be a ‘share’ of a cost item) . List the costs that your are seeking funding from Napier City Council FIRST. (see example at the end of this form) Item Cost Amount of funding requested from Napier City Council Amount from other contributors e.g. own organisation/other funder/sponsorship/user fees etc A: Total B: Total C: Other Contributions Please list all the other funders you have applied to for funding for this project or service Funder Amount Requested Outcome (Approved, declined or enter the date the outcome will be known) Total Funding Requested (Total $ Request Total Funding Amount requested (Total D from Q 9 - GST exclusive) $ Total amount requested from NCC (Total B from Q 8 above) $ Is your organisation, and/or staff, required to meet external accreditation/audit requirements in order to provide its services? (eg CYFS acreditation, industry registration etc) No – go to question 12 Yes – what accreditation or audit requirements apply? Please List:
CSG-Application-Form-Community-Service-Grant-2018-19.docx