Grant Application Form - EXTREME OUTREACH SOCIETY
The detailed grant application submitted by the Extreme Outreach Society for their office renovation project.
Grant Application Form
Basic Information
For what type of grant are you applying?
Category: [ ] Establishment [ ] Operational [ ] Special Project
Project / Program Name & Description: EXTREME OUTREACH SOCIETY OFFICE Reno - Coffee Bar
Grant amount applied for? $ 5000 % of project budget 10 % Date the project, activity, event or program will occur: AUGUST 1
Has your organization ever received grant funding from the Town? No
Has your organization received a permissive tax exemption from the Town? No
Does your organization issue grants to other organizations? No
Attachments Required [ ] Resolution of Board of Directors to request a Grant in Aid from the Town of View Royal. [ ] Prior years financial statements of the organization.
About Your Organization
Legal Name of Organization: EXTREME OUTREACH SOCIETY Mailing Address: #102 - 284 HELMCKEN RD VICTORIA BC V9B 1T2 Operating at: #102 - 284 HELMCKEN RD VICTORIA BC V9B 1T2 Ph: 250-389-2064 Fax: Email: OFFICE@EXTREMEOUTREACH.COM Contact: CLIFF POWER Title: EXECUTIVE DIRECTOR Society Registration Number: S-0042202 Year Registered: 1998 Charity Registration Number: 89221 3414 Year Registered: 1998 Year Founded: 16 Fiscal year end: 31 / 12 (day/month) List any other geographic areas in which your organization operates: GREATER VICTORIA
Your Organization’s Personnel
1) Organization Executive and Staff:
- President: CLIFF POWER Telephone: 250-389-2064
- Secretary/Treasurer: NOLA PAXTON Telephone: 250-882-0031
Board Members:
- JOHN JORDAN
- MAHESH KUMAR
- JULIE GREEN
- Nola Paxton
- Cliff Power
2) List the staff or volunteer positions involved in carrying out the project:
| Name and Position | Paid | Volunteer |
|---|---|---|
| OFFICE Admin - Student | ||
Your Organization’s Objectives and Services
1) Describe your organization’s mission statement and how your services meet them: EXTREME OUTREACH SOCIETY IS COMMITTED TO PROVIDING HOLISTIC DEVELOPMENT AND MENTORSHIP TO VICTORIA'S CHILDREN-AT-RISK IN A SAFE, POSITIVE, NON-DISCRIMINATORY ATMOSPHERE.
Your Proposed Program Budget
SEE ATTACHED FINANCIAL STATEMENTS
1) 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 | N/A | N/A |
| Government Revenue (specify) | ||
| Interest income | ||
| Bingo revenues | N/A | |
| Direct access revenues | ||
| Fundraising projects | ||
| Other Revenue (specify) | ||
| TOTAL INCOME | SEE ATTACHED | STATEMENTS |
| B. Expenses | ||
|---|---|---|
| Administration | ||
| Wages/Honouraria/Benefits | ||
| Supplies and Equipment | ||
| Major Capital Costs | ||
| Mortgage/Rent/Utilities | ||
| Fees (licensing, etc.) | ||
| Insurance | ||
| Advertising/Printing/etc. | ||
| Other (specify) | ||
| TOTAL EXPENSES |
Details of Your Organization’s Grant Request
1) Nature and goals of the project: SUPER KIDS SAT FEB - MAY - Provide Lunch, games & SAFE MORAL TEACHINGS For children aged 6-12.
SUPERKIDS CAMP - 1 WEEK OVERNIGHT CAMP including all MEALS, ACTIVITIES FOR CHILDREN AGED 6-12.
BOTH TO PROVIDE A SAFE ENVIRONMENT FOR LOW INCOME CHILDREN TO EXPERIENCE HOW TO WORK WITH OTHERS & TO BUILD THEM INTO THE LEADERS OF TOMORROW.
2) Summary of direct and indirect benefits to the Town of View Royal taxpayers:
- CHILDREN OF VIEW ROYAL WOULD HAVE ACCESS TO OUR PROGRAMS WHICH THEY MIGHT NOT HAVE BEFORE.
- POSSIBLE SECOND LOCATION FOR OUR SAT PROGRAM & OUR CHRISTMAS DINNER & STOCKING PROGRAMS.
Conditions of Funding
- The applicant must acknowledge the support of the Town in all printed and publicity material related to the project;
- Funds must be used for the purpose for which they were requested. Any funds not used for the requested purposes 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 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, are completed.
- Organizations receiving grants from the Town shall provide an accounting of the event or purpose for which the grant was approved as follows: a. Where the grant in aid was for a specific project the applicant must submit a final report within 45 days after the project. 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 organizations fiscal year.
- An annual report must include the following information: i. Evaluation of the project; ii. Financial statement of actual revenue and expenses for the project, if applicable; iii. Attendance figures, if applicable; iv. Number of participants in the project; and v. Evaluation of the impact to the Town.
- In the event that the project 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: CLIFF POWER Title: EXECUTIVE DIRECTOR Date: JULY 16, 2014
Name: Title: Date:
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
Grant Applications must be received by the Town on or before March 1st of each year
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