Community Service Grant Application

The City of Yellowknife provides one (1) year Community Service grant funding to non-profit organizations based in Yellowknife for start-up or enhancement of programs or projects. The maximum amount to be awarded is 30% of the submitted budget to a maximum of $10,000.

Funding must be used within the grant year.

See the Grant Funding Policy for more information about application requirements.

1. Current Community Services Grant Application
2. Complete

See the Grant Funding Policy for more information about application requirements.

Organization Information

Name of Organization

NWT Societies Act Registration Number

Mailing Address

Address

City/Town

Province

Postal Code

Contact Person

Role/Title of Contact Person

Email Address of Contact Person

Please Provide:

Describe your organization

Is your organization in good standing with the City of Yellowknife? (e.g. taxes, permits, or outstanding grant reports) If not, please explain.

Is your organization in Yellowknife and serving the community of Yellowknife? If no, please explain.

Select the Funding Priority that applies to this application:

Sports and Recreation

Culture

Community

Arts

Explain how your programs and/or projects meet the criteria in the Grant Funding Policy

What is the amount of funding your organization is requesting?

Describe your program, project, service or event and explain why it should be funded

Who is your target audience and how many people are expected to attend?

What is the frequency of the program, project and/or event? (e.g. one time, weekly, or annually)

Is your program inclusive, accessible and affordable? Please explain.

What other partnering organizations are involved with this event? How are they involved?

How will the City of Yellowknife be recognized in the advertising and marketing of your event?

Please list all the members of the organization's Board of Directors (including name, position, address, phone number)

If successful, your organization must provide proof of Insurance with a minimum $2,000,000 in liability insurance. The City of Yellowknife must be listed as additional insurer on the policy.

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Corporate Registry Profile Report (proof that you are current with Societies)

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Financial Information

Please provide your budget revenues; see a sample Budget Revenues table below:

Revenues
Ticket Sales	$44,000
Tour Revenue	$3,000
Fundraising Raffle	$30,000
Total	$77,000

Budget - Revenues

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods xls xlsx.

Please provide your budget expenditures; see a sample Budget Expenditures table below:

Expenditure
Advertising	$8,000
Website	$1,000
Insurance	$3,000
Total	$12,000

Budget - Expenditures

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Signed Financial Statements from your most recent Annual General Meeting (Signed by TWO current board members). This must include an Income Statement (listing revenues and expenses) and a balance sheet (listing assets, liabilities and equity):

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Please read and sign

Use of Funds

The Organization hereby agrees to use the funds or services provided to the Organization only in the manner set out in this application. The City of Yellowknife reserves the right to request, at any time, the return of any of those funds if the Organization uses the funds in a manner that, in the opinion of the City, is inconsistent with the objectives of the City of Yellowknife Grant Funding Policy or with the description of the intended use of the funds as set out in the application or should it be discovered that the undersigned made a material misrepresentation in the application.

Privacy Policy

The City of Yellowknife is committed to protecting the privacy and confidentiality of personal information. All personal information that is collected by the City is used for the City to Yellowknife Grant programs.

Representations

In making this application, we the undersigned board member(s)/Executive Director hereby represent to the City of Yellowknife and declare that, to the best of our knowledge and belief, the information provided in this application and the related attached supporting documents are truthful and accurate and the application is made on behalf of the Organization and with the full knowledge and consent of the Board of Directors.

Executive Director or Board Member Signature

Sign above

Today's Date

Final Report

All recipients of Heritage Committee grants must submit a final report for grant funding by December 15 of the year the grant was awarded, or within 60 (sixty) days of the event, program or project's end. The final report must consist of a summary of the project completed, photos or materials used for media ads and expenditures. Unlike Community grants, there is no specific format or template for this report.

1. Current Grant Funding Final Report Form
2. Complete

Organization Information

Name of Organization

Contact Person

Phone number of Contact Person

Email address of Contact Person

Program or Project Information

Name of event, program or project

What was successful about your event, program or project?

How was the City of Yellowknife recognized at your event, program or project?

How many people attended your event, program or project?

Photos of your event, program or project

Unlimited number of files can be uploaded to this field. 250 MB limit. Allowed types: gif jpg jpeg png.

Financial Information

Please provide your revenues; see a sample Revenues table below:

Revenues
Ticket Sales	$14,000
Tour Revenue	$3,000
Fundraising Raffle	$30,000
Total	$47,000

Final Report Revenues: revenues must correspond to those submitted in the original grant application

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Please provide your expenditures; see a sample Expenditures table below:

Expenditures
Advertising	$10,000
Venue Rental	$34,000
Insurance	$3,000
Total	$47,000

Final Report Expenditures: expenditures must correspond to those submitted in the original grant application

One file only. 250 MB limit. Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Please read and sign

Use of Funds

The Organization hereby agrees to use the funds or services provided to the Organization only in the manner set out in this application. The City of Yellowknife reserves the right to request, at any time, the return of any of those funds if the Organization uses the funds in a manner that, in the opinion of the City, is inconsistent with the objectives of the City of Yellowknife Grant Funding Policy or with the description of the intended use of the funds as set out in the application or should it be discovered that the undersigned made a material misrepresentation in the application.

Privacy Policy

The City of Yellowknife is committed to protecting the privacy and confidentiality of personal information. All personal information that is collected by the City is used for the City of Yellowknife Grant programs.

Executive Director or Board Member Signature

Sign above

Today's Date