CHARITIES & DEVELOPMENT

GRANTING PROGRAM

2018 FUNDING

APPLICATION

Funding provided by

Together in Action

TABLE OF CONTENTS

Contents

SECTION 1 – ORGANIZATION INFORMATION

SECTION 2 – PROJECT INFORMATION

SECTION 3 – FINANCIALS

1.BUDGET WORKSHEET

2.PRIOR YEAR’S FUNDING

3.AUDITED FINANCIAL STATEMENTS

SECTION 4 – ATTACHMENTS

SECTION 5 – CERTIFICATION AND SIGNATURE REQUIREMENTS

2018 FUNDING APPLICATION1

CHARITIES & DEVELOPMENT GRANTING PROGRAM

SECTION 1 – ORGANIZATION INFORMATION

1.Legal Name of Applicant
(as registered with the CanadaRevenue Agency)
Mailing Address
(including Postal Code)
Street Address of Applicant
(if different from mailing address)
Telephone
Fax
Email
Website
2.CRA Charitable Number
3.Leadership
Executive Director(or equivalent) Name
Title
Phone
Fax
Email
4.Application Contact
Name
(if different than Executive Director)
Title
Telephone
Fax
Email
5.Do you have a person in your organization who can make a presentation to a parish?
If yes, list name, title, phone, email, and preferred language
6.What is your Organization’s Mission?
7.What is your total annual budget?
8.Briefly describe your organization’s overall service.
9.Does your organization have insurance to meet the need and risks related to the services you provide?
10.Does your organization have volunteer / staff screening / training for those working with vulnerable individuals?
(If yes, elaborate and include a copy of your manual(s) with this application)
11.Describe your organization’s Sanctity of Human Life Philosophy and how it guides services you provide.
(E.g. counselling, referrals, partnerships)

SECTION 2 – PROJECT INFORMATION

1.Briefly describe the project for which you are seeking funding for.
2.What is the total project budget?
3.What is the amount you are requesting from this Funding Program?
(Remember, it cannot be the total amount of the project budget)
4.How does this project help your target population?
Choose ONE
AdvocacyBasic NeedsCounselling
EducationRecreationSpiritual
Other
If you chose “Other,” please elaborate:
5.What is the key focus of the project?
Choose ONE
AccessibilityEducation & Literacy
Family ViolenceHealth & Wellbeing
Homelessness & PovertyImmigration
JusticeSanctity of Life
Social IsolationOther
If you chose “Other,” please elaborate:
6.Who is your target population?
Choose ONE
ChildrenYouthYoung Adults
AdultsFamiliesSeniors
AllOther
If you chose “Other,” please elaborate:
Choose an item. /
7.What is the target population’s gender?
(Make a selection from the right.)
MaleFemaleBoth
8.What are the start and finish dates of your project?
Start:
Finish:
9.How many full time staff are employed by the project?
10.What is the geographic area served by the project?
11.What is number of clients served by this project?
12.Briefly describe how your project addresses the needs of your target population and how financial assistance will enable you to help them in the short term and in the foreseeable future.
13.Describe what is unique about this project or activity and how it differs from similar projects, activities or services offered in your community.
14.Describe any formal collaborative arrangements you have with other agencies/organizations in the community and how the collaboration supplements or complements the service provided.
15.What are the outcomes you wish to achieve with your clientele? Explain how you will know if the desired outcomes have been achieved.
16.Describe the evaluation instrument(s) you will use to measure the overall effectiveness of the project.

SECTION 3 – FINANCIALS

1.BUDGET WORKSHEET

Attach or use the following format to provide your Agency Budget for the period for which funding is sought.

If applying for a specific program/project, provide that budget too.

REVENUEBUDGETED AMOUNT

Government Grants

(Provide program name, government level & anticipated support)

$

Foundation Grants (provide foundation name and anticipated support)

Fundraising Projects (event name/fundraising type and anticipated success)

Other Sources of Revenue (user fees, donations, etc.):

$

Funding Requested from the Diocese of Calgary$

TOTAL INCOME:$

EXPENSESBUDGETED AMOUNT

Staff Salaries (do not include fee-for-service programs)$

Employee Benefits (employer’s share only)

Building Occupancy (rent, utilities, repair & maintenance, taxes, insurance, etc.)

Office Expenses (supplies, postage, copying, phone, etc.)

Recruitment and Education (conferences, workshops, training, etc.)

Promotion and Publicity (ads, entertainment, awards, etc.)

Purchased Services (legal fees, consulting fees, audits, etc.)

Transportation (mileage, parking, bus fares, air fares, etc.):

Miscellaneous (list expenditures which do not fit under the above classifications)

TOTAL EXPENDITURES$

SURPLUS (DEFICIT) balanced budget should be $0$

2.PRIOR YEAR’S FUNDING

When was the last year your agency received funding from this Program?

What was the amount received?

Was the funding received from this Program in the previousyear was utilized fully on the Approved Program asdescribed in the Funding Agreement for that year.

☐Yes

☐No

If no, explain

3.AUDITED FINANCIAL STATEMENTS

DOCUMENTATION

Attach a copy of your agency’s most recent Audited Financial Statements.

If your agency does not have professionally Audited Financial Statements, include a copy of the financial statements which you submitted to the Canada Revenue Agency as part of your T3010 Public Information Return. If not professionally audited, statements must be signed by your Financial Officer and one other member of your Board Executive.

TRANSPARENCY

It is expected that agencies funded by the Program have transparent reporting practices including clear indications of General & Administrative Expenses.

Please ensure that your financial statements are consistent with the information provided on your T3010.

SECTION 4 – ATTACHMENTS

ATTACHMENT CHECKLIST(MUST accompany your application)

☐List of the names and addresses of Board of Directors and their positions

☐Summary of most recent program evaluation results

☐Copy of program evaluation instrument(s)

☐Volunteer / staff screening / training manual

☐Most recent audited financial statements as outlined in Section 3 (3)

☐Most recent Annual Report or Year-end Summary

☐Volunteer and staff screening and training manual

SECTION 5 – CERTIFICATION AND SIGNATURE REQUIREMENTS

On behalf of the Applicant, we, the undersigned, hereby certify that we are duly authorized to represent, execute and deliver this application on behalf of the Applicant. We further certify that the information contained in this Application Form, together with the supplementary documentation supplied herewith, is accurate, true and complete in all material. Use of Electronic signature is acceptable

SignatureSignature

NameName

Board of Directors ChairFinancial Officer

DateDate

Signature

Name

Executive Director

Date

2018 FUNDING APPLICATION1

CHARITIES & DEVELOPMENT GRANTING PROGRAM