Grants Application Form

   

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Municipality of the County of Annapolis Grant Application Form



Name of organization
: _____________________________________________________________________

 

Contact Person (name): _____________________ Position in the organization: ________________

 

Mailing address: __________________________________________________________________________

 

Postal Code: ____________ Telephone number: ______________ CELL: ___________________

 

E-mail: __________________________________ FAX: _________________________

 

  1. Organization Executive: Attach a list of the Executive of your organization, (e. President, Vice President, Treasurer & Secretary)

 

  1. Constitution or Bylaws: Please ensure that the County has an up-to-date copy of your constitution or bylaws

 

  1. Please provide if applicable a NS Registry of Joint Stock Number: ____________ or Federal Charitable Status Number: ______________

 

  1. The Project: Title of project / program: _____________________________________ Attach an explanation of the project or program for which funding is being requested, including the goals, objectives and benefits to the community and/or county.  

 

  1. Financial information - Please provide the following:
  2. Amount Requested from the County $ _________________

 

  1. Complete the budget information below, which includes: all projected sources of revenue for the project, including “in-kind” volunteer contributions if appropriate and all projected expenses to initiate the program or complete the project.

 

  1. A copy of the most recent financial statements for the organization including Statement of Income and Balance Sheet. If statements are not available at the time of application, please indicate below the date by which a copy will be provided:______________________________________________

 

 Expenses (for Project or Program)

Item                                                                            Cost                             

________________________________________________________________

_________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

___________________________________________________________________

_________________________________________TOTAL______________________

Revenues

Source                                                                 Amount                               

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

_________________________________________TOTAL_____________________



Note:  The expense total should equal the revenue total (balanced budget).  

I certify that the information supplied in this application is, to the best of my knowledge, exact and complete, and that the project has received the approval of the organization I represent.

 

Date: __________________________________ Signature: ________________________________

Completed applications can be either:

Emailed to the below address, or dropped off at one of our municipal offices or mailed to:

Community Grants Program, County of Annapolis

271 Granville St. PO Box 609, Bridgetown, NS

B0S-1C0

If you need assistance at any time please contact (902) 665-3022 or email nchisholm@annapoliscounty.ca

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