Depatment of Tourism, Heritage and Culture

Sport and Recreation Branch

Please refer to our program guidelines at the following website:
OR
Contact your regional consultant at:

Application for financial assistance – PROFILE

1. / INFORMATION ABOUT YOUR ORGANIZATION
a) / Official name of organization :
b) / Person completing application :
c) / Complete mailing address of applicant:
Municipality: / Prov.: / Postal code:
d) / Tel.:
e) / Fax:
f) / Email:
g) / Type of organization :
Municipality / Recreation
First Nation / Multi-sport
Regional Service Commission / Other
Sport
2. / DETAILS CONCERNING THE ORGANIZATION’S ACTIVITIES
a) / Name of project / activity
b) / Location of project / activity:
c) / Is your program / project inclusive or do you have a specific target population?
Yes No: If no, please specify: double click for listAboriginalPerson with a disabilityEconomically disadvantagedWomen/GirlsOther
Aboriginal / Person financially disadvantaged
Person with a disability / Women/Girls
d) / Does your organization support the New Brunswick's Recreation and Sport Policy Framework? Yes No
e) / Please list your partners, their role and/or qualifications and type of in-kind (i.e.: volunteer work, equipment, transportation, facilities, other )within your organisation.
Partner / Contact Person / Role / Qualification / Type of in-kind contribution (double click to access list)
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
f) / What kind of training / certification do your leaders and coaches currently have?
Community Coach / Principles of Healthy Child Development
Introduction to competition / High Five Sport
Introduction to competition (ADVANCED) / Healthy Minds for Healthy Children
Competition / Development / Quest 1-2
High Five Trainer / Sport Trainer / Multisport (Coach NB)
Professional Development Points / Active Kids
Aborginal coaching model / Making Head Way
Physical Litteracy workshop / Official Training / Certification
Superhero Training / Other
g) / Do the coaches, officials and leaders of your organization require training?
Yes / No
If YES, please specify the location, date, cost, number of participants and types of training.
h) / New project Enhanced project
i) / Are you a Provincial Sport Organization (PSO) member? Yes No If yes, which one:
j) / Please check off all that applies to your organization.
Constitution / Coaches required to have ethics training
Incorporation / Code of conduct policy
Bylaws / Your organization is aware of the Rule of Two
Volunteer screening policy that includes background checks / Your organization has adopted a sport related concussion policy
Your organization has a social media policy
k) / Please indicate the number of participants, instructors, officials and administrators registered with the organization.
Male / Female
Participants / athletes
Instructors / coaches
Officials
Volunteers
TOTAL
l) / Total number of clubs within your organization.
m) / Does your organization use a concussion Protocol? Yes No
If yes, please indicate name of Protocol:
n) / Does your organization use a concussion recognition tool? Yes No
If yes, indicate which tool :
3. / ANNUAL PLANNING - AREAS OF FUNDING
►
► / ORGANIZATION
Some specific examples would include organization development activities and projects, ongoing regional organization/administration operational costs, promotion, planning workshops and profile meetings.
ATHLETE DEVELOPMENT/PHYSICAL ACTIVITY/RECREATION INITIATIVES
Include introductory and development projects organized to initiate a new or ongoing program. Financial contributions may be available towards promotion, honorarium, travel, lodging, meals and expenses of resource people.
►
► / LEADERSHIP
Include training projects for volunteers, instructors, coaches, officials and administrators. Financial contributions may be available towards honorarium, travel, lodging, meals and expenses of resource person.
ADAPTIVE EQUIPMENT FOR PARTICIPANTS
A financial contribution may be available on a cost sharing basis for adaptive equipment costs to assist the participation of persons with disabilities in recreation and sport programs.
ANNUAL PLAN
Description of activity; Give specific details / Location / Date / # participants / Amount required
Are you submitting any LTAD appendix? Yes No If yes, how many?
BUDGET – REVENUE AND EXPENSES
Organization`s contributions
Please Indicate ALL Revenues / EXPENSES
Please Indicate ALL Expenses
Estimated funding / Cash / In Kind / In Kind value / Estimated Expenses / Amount
Registration / Memberships / $ / Honorarium / $ / Equipment / $
Fundraising / $ / Installations / $ / Insurance / $
Sponsors / $ / Equipment / $ / Administration / Publicity / $
Other grants / $ / Volunteers / $ / Training (Board and officials) / $
$ / Other / $ / Honorarium / $
$ / $ / Adaptive equipment / $
$ / $ / Facility rental / $
$ / $ / Physical activity / $
$ / $ / Athlete development / $
$ / $ / Competition / $
$ / $ / Coach training / $
$ / $ / Other / $
$ / $ / LTAD Training / $
$ / $ / LTAD Equipment / $
$ / $ / LTAD Facility rental / $
TOTAL / $ / TOTAL / $ / TOTAL / $
Amount requested from Department: / $
Do you already have direct deposit? / Yes / No
This application can be sent to your regional consultant by email at ; by fax at or by mail to the following address: Sport and Recreation Branch, Please consult our regional map for more information.
4. / CHANGES IN ORGANIZATION
Official name of organization:
Official address of organization :
Date of last annual general meeting :
ELECTED / REPLACES
President: / President:
Address: / Address:
Telephone: / Telephone:
Fax: / Fax:
Email: / Email:
Admin 1: / Admin 1:
Address: / Address:
Telephone: / Telephone:
Fax: / Fax:
Email: / Email:
Admin 2: / Admin 2:
Address: / Address:
Telephone: / Telephone:
Fax: / Fax:
Email : / Email:
5. / CHECKLIST
LTAD documents included. / Yes / No
Direct deposit form is included / Yes / No / N/A
6. / DATE SUBMITTED AND SIGNATURE
Date / Signature:

24/04/2018

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