District of West Vancouver
Annual Accountability Form for 2017 grants
Deadline for Submission: January 31, 2018
Name of Organization: ______
Name of program or service funded: ______
Contact person: ______Position: ______
Mailing address:______
City: ______Postal code: ______
E-mail: ______Telephone: ______
Community Grants are given out on a one-time basis and in two and three-year funding cycles. Please check one boxin column A and one box in column B below to indicate the year and cycle that your organization was in during 2017.
COLUMN ACOLUMN B
□1st year □3 year funding cycle
□2nd year □2 year funding cycle
□3rd year □one-time funding cycle
Amount of West Vancouver Community grant received in 2017 $______
Please attach:
most recent year end financialstatements
most recent annual report
- Number of West Vancouver residents served by your organization as a result of the funding through the Community Grants program: ______
- Please describe how, in the last year, the funds granted to your organization from the Community Grants program have made a difference to the residents of West Vancouver.
______
______
3.Please describe any significant changes in your organization related to funding, mandate, goals and objectives, status of board and operational effectiveness in 2017.
______
4.Please describe other contributions and in kind support received from the District of West Vancouver.
______
______
______
______
5.Every year we endeavour to showcase the valuable contribution your organization makes to our community. Through an annual report to Council which highlights West Vancouver’s Community Grants program and reaches a broader audience through our website and local media.
To give this year’s report greater impact we need your help by providing a photograph or a brief testimonial illustrating the service you offer. Pictures may be submitted electronically or in print.If you prefer to provide a testimonial, simply attach a separate page to this form. Please note that your organization is responsible for obtaining a signed photo release from any persons in the photograph.
6.Grant recipients must acknowledge assistance on written and web-based material relating to the organization or project with the following:
We gratefully acknowledge the support of the District of West Vancouver through their Community Grants program.
Please indicate how this requirement has been met.
______
Name:______Position: ______
Signature:______Date: ______
Forward this completed formand required documentation by January 31, 2018, 4:30p.m. to Hong Tjhie, Department Secretary.
Email:
Mail:Parks, Culture and Community Services Administration
3rd Floor, West Vancouver Community Centre
2121 Marine Drive
West Vancouver, BC V7V 4Y2
Fax:604-921-3405
To speak with someone about your annual accountability form, please contact Hong Tjhie at 604-921-2921.
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