Grant Application Form - Island Corridor Foundation
Grant application from the Island Corridor Foundation seeking a Grant in Lieu of Taxes for 2013.
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: GRANT IN LIEU OF TAXES.
Grant amount applied for? $ 5900 EST % of project/event/program budget __________%
Date the project, activity, event or program will occur: 2013
Has your organization ever received grant funding from the Town? No (circled)
- If yes, attach copies of printed material which acknowledged the financial support of the Town.
Has your organization received a permissive tax exemption from the Town? Yes (circled)
- If yes, in what year(s)? _________
Does your organization issue grants to other organizations? No (circled)
- 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. (to be obtained MARCH 28)
- 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: ISLAND CORRIDOR FOUNDATION Mailing Address: P.O BOX 375, STATION A. NANAIMO BC V9R 5L3 Operating at: 7 PORT WAY, NANAIMO BC Ph: 250 754 7254 Fax: 1 888 662 4497 Email: islandrail@shaw.ca Contact: JIM DIAS Title: MUNICIPAL LIAISON Society Registration Number: __________ Year Registered: 2006 Charity Registration Number: __________ Year Registered: __________ Year Founded: 2006 Fiscal year end: 31 / 12 (day / month)
List any other geographic areas in which your organization operates: VICTORIA TO COURTENAY PARKSVILLE TO PORT ALBERNI
Your Organization’s Personnel
1) Organization Executive and Staff:
- President: MARY ASHLEY Telephone: c/o 250-246-4320
- Secretary/Treasurer: GRAHAM BRUCE / JOHN BELIKOFF Telephone: ✓ / ✓
Board Members:
- JUDITH SAYERS
- LENNIE MORRIS
- PHIL KENT
- ALBIE CHARLIE
- GARRY JANGULA
- TED GREVES
- GRAHAM HILL
- RAY GAUTHIER
- KEN MCRAE
- DAVID BOB
2) List the staff or volunteer positions involved in carrying out the project:
| Name and Position | Paid | Volunteer |
|---|---|---|
| GRAHAM BRUCE, CHIEF OPERATING OFFICER | ✓ | |
| JOHN BELIKOFF, CHIEF FINANCIAL OFFICER | ✓ | |
| JANICE ROBERTS, OFFICE ADMINISTRATOR | CONTRACTED | |
| JIM DIAS, MUNICIPAL LIAISON | ✓ | |
| DEL WRIGHT, PROPERTY LANDS MGR | ✓ | |
| NICOLE MORRIS, FIRST NATION'S LIAISON | ✓ |
Your Organization’s Objectives and Services
- Describe your organization’s mission statement and how your services meet them: (See Attached)
Your Proposed Program Budget (SEE ATTACHED 2013 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 | ||
| Fees or Membership Dues | ||
| Government Revenue (specify below) | ||
| Interest income | ||
| Bingo revenues | ||
| Direct access revenues | ||
| Fundraising projects | ||
| Other Revenue (specify below) | ||
| TOTAL INCOME |
| B. Expenses | ||
|---|---|---|
| Administration | ||
| Wages/Honouraria/Benefits | ||
| Supplies and Equipment | ||
| Major Capital Costs | ||
| Mortgage/Rent/Utilities | ||
| Fees (licensing, etc.) | ||
| Insurance | ||
| Advertising/Printing/etc. | ||
| Other (specify below) | ||
| TOTAL EXPENSES |
Details of Your Organization’s Grant Request
Nature and goals of the project, program or event: GRANT IN LIEU OF TAXES. ON FOLIO #'S 18807.020 18807.010
Summary of direct and indirect benefits to the Town of View Royal: see 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.
- A 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: JIM DIAS Title: MUNICIPAL LIAISON Date: MARCH 11/2013
Submission Information
Please submit your completed application to: Town of View Royal 45 View Royal Ave Victoria, BC V9B 1A6 Fax 250-727-9551 email: finance@viewroyal.ca