Grant Application Form - BC SPCA Wild ARC Avian and Mammal Enclosure Upgrades
Grant application from the BC SPCA Wild Animal Rehabilitation Centre for upgrading outdoor enclosures for birds and mammals.
Grant Application Form
Grant Applications must be received by the Town on or before March 1st of each year
Basic Information
For what type of grant are you applying?
Category: [x] Specific Project [ ] Special Event [ ] Program (annual operations)
Project / Event / Program Name & Description: Avian and mammal Enclosure Upgrades
Grant amount applied for? $2,500 % of project/event/program budget: 5 % Date the project, activity, event or program will occur: Complete by Dec 2013
Has your organization ever received grant funding from the Town? [Yes] / No
- If yes, attach copies of printed material which acknowledged the financial support of the Town. 2008 ($3000) attach website
Has your organization received a permissive tax exemption from the Town? Yes / [No]
- If yes, in what year(s)? ________
Does your organization issue grants to other organizations? Yes / [No]
- If yes, you must demonstrate that any funding provided by the Town will not be used to fund grants to other organizations and attach it to this grant application form.
Attachments Required
[ ] Resolution of Board of Directors to request a Grant in Aid from the Town of View Royal. ** If there is no Board of Directors, a statement of request must be signed by the majority of the members of the non-profit or community organization.
[x] Prior years financial statements of the organization. [ ] Documentation Town funding will not be used to fund grants to other organizations (if applicable)
About Your Organization
Legal Name of Organization: BC SPCA Wild Animal Rehabilitation Centre (Wild ARC) Mailing Address: 1020 Malloch Road, Victoria BC V9C 4G9 Operating at: above
Ph: 250-478-9453 Fax: 250-478-6213 Email: sdubois@spca.bc.ca Contact: Sara Dubois Title: Manager of Wildlife Services Society Registration Number: PCA Act Year Registered: 1895 Charity Registration Number: 11881 9036 RR0001 Year Registered: 1895 Year Founded: 1895 Fiscal year end: 31 / 12 (day / month) List any other geographic areas in which your organization operates: British Columbia
Your Organization's Personnel
1) Organization Executive and Staff: President: Marylee Davies Telephone: mdavies@spca.bc.ca Secretary/Treasurer: Eric Stebner Telephone: erics@akhurst.com
Board Members:
- Kristin Bryson
- Karen Holland
- Michelle Grant
- Lorna Medd
- Linden Loughridge
- Romany Runnalls
- Kathi Travers
- Ryan Layton
- Peter Havlik
- Barbara Sharp
- Cindy Soules
2) List the staff or volunteer positions involved in carrying out the project:
| Name and Position | Paid | Volunteer |
|---|---|---|
| Sara Dubois, manager of Wildlife Services | [x] | |
Your Organization's Objectives and Services
- Describe your organization's mission statement and how your services meet them: attached
Your Proposed Program Budget
- Please list all expenses and sources of project revenue, including "in-kind" contributions from your (or any other) organization.
| A. Income | Last Fiscal Year (if program was in existence) | This Fiscal Year (Proposed program budget) |
|---|---|---|
| Town of View Royal | 2,500 | |
| Fees or Membership Dues | ||
| Government Revenue (specify below) | ||
| Interest income | ||
| Bingo revenues | ||
| Direct access revenues | ||
| Fundraising projects (designated donations) | 40,000 | |
| Other Revenue (specify below): Municipal grants (applications to Saanich, Highlands, Sidney, Esquimalt, Colwood, Langford) | 7,500 | |
| TOTAL INCOME | 50,000 |
| B. Expenses | Last Fiscal Year | This Fiscal Year |
|---|---|---|
| Administration | ||
| Wages/Honouraria/Benefits | ||
| Supplies and Equipment | ||
| Major Capital Costs (see attached) | 50,000 | |
| Mortgage/Rent/Utilities | ||
| Fees (licensing, etc.) | ||
| Insurance | ||
| Advertising/Printing/etc. | ||
| Other (specify below) | ||
| TOTAL EXPENSES | 50,000 |
Details of Your Organization's Grant Request
Nature and goals of the project, program or event: attached
Summary of direct and indirect benefits to the Town of View Royal: attached
Conditions of Funding
- The applicant must acknowledge the support of the Town in all printed and publicity material related to the project, event, or program;
- Funds must be used for the purpose for which they were requested. Any funds not used for the requested purpose must be returned to the Town.
- Funds will be released as follows: a. Grants in aid provided for annual programs will be released at 100% at time of approval by Council; b. Grants in aid provided for special projects or events will be released at 50% at time of approval by Council and 50% after receipt of the final report; c. Conditional grants in aid will be paid 100% upon satisfactory proof that the conditions, as set by Council, have been met.
- Organizations receiving grants from the Town shall provide an accounting of the project or program for which the grant was approved as follows: a. Where the grant in aid was for a specific project or event the applicant must submit a final report within 45 days after the project or event is complete. b. Where the grant in aid was in support of an annual program, the applicant must submit a final report within 60 days of the end of the organization's fiscal year.
- An final report must include the following information: i. Evaluation of the project, event, or program; ii. Financial statement of actual revenue and expenses for the project, event or program; iii. Attendance figures, if applicable; iv. Number of participants in the project, event, or program; and v. Evaluation of the direct and indirect benefits to the Town.
- In the event that the project or program is not completed, the grant recipient organization must notify the Town as soon as practical and refund any grant funds that have been provided for that project.
Your Directors' Declaration
We, the undersigned, do hereby certify that this application and all appended forms and/or documents contain a full and accurate account of all matters stated:
Name: Sara Dubois Title: Manager of Wildlife Services Signature: [Signed] Date:
Name: ________________ Title: ________________ Signature: ________________ Date: ________________
Document Images
(5)
