Grants Application Form
Name of organization: _____________________________________________________________________
Contact Person (name): __________________________ Position in the organization: ________________
Mailing address: __________________________________________________________________________
Postal Code: ____________ Telephone number: ______________________ CELL: ___________________
E-mail: __________________________________ FAX: _________________________
Please provide the following information included with this application form:
1. Organization Executive: Attach a list of the Executive of your organization, (i.e. President, Vice President, Treasurer & Secretary)
2. Constitution or Bylaws: Please ensure that the County has an up-to-date copy of your constitution or bylaws
3. NS Registry of Joint Stock Number: __________Federal Charitable Status Number: ________________
4. The Project: Briefly explain the project or program for which funding is being requested, including the goals and objectives in the space below and/or you may provide a brief cover letter.
Will any new programs or projects be started as a result of this grant?
Yes No Please explain: _____________________________________________________________
5. Financial information: Amount Requested from the County $ ________________________________
a. Please provide a 12-month Project or Program Budget 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.
b. Copy of 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: ________________________________________________
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 sent in by mail, fax or email and/or if you require assistance, please phone 902-665-3022 or email: email@example.com
County of Annapolis - Bridgetown Office – 271 Granville St., Bridgetown NS, B0S-1C0