South West Presbytery Mission Support Grant Program: Application Short Form

South West Presbytery
Mission Support Grant Program

Grant Application Short Form

(for grant applications up to $5,000)

To facilitate your application be sure to consult and follow
the relevant sections of the Mission Support Grant Program’s
Policies and Procedures guide, available on the South West Presbytery website or from the presbytery office.

South West Presbytery
Toronto Conference

The United Church of Canada

L’Église Unie du Canada

For assistance please visit the website: www.torontoconference.ca/southwest/
or call 1.800.446.4729 or 416.241.2677 ext. 6263, or e-mail

2016.07

Part One: Organization Details

Contact Information

Name of Organization
Primary Contact
Title
Mailing Address
City / Prov / Postal Code
Daytime Phone / E-mail
Fax / Website
CRA Charitable Registration No.
(if applicable)
Have you received grant monies from South West Presbytery before? / £ Yes
£ No / If “yes,” under what name?

Application Approval

This application has been approved by: (check all that apply)
Please note: if your initiative requires additional Presbytery approval (e.g., capital improvements), please include related documentation with your application.
£ Session / £ Board / £ Council of Local Ministry Unit / £ Other Ministry
£ Camp / £ School / £ Outreach Ministry / £ Other
Name of Local Ministry Unit
Print Name of Signing Officer
Title of Signing Officer
Signature of Signing Officer
Date

Part Two: Overview of the Initiative

Title of the Initiative
Is this a new initiative? / £ Yes £ No

Description of the Initiative (100 words maximum)

What makes this initiative distinctive? (250 words maximum)

Goals of the Initiative (250 words maximum)

Part Three: Initiative’s Revenues and Expenses

Be sure to include your local ministry unit’s or organization’s most recent financial statements.

Revenues

Revenues / Amount / Confirmed (Yes/No) / Anticipated Grant
Confirmation Date
Organization Funds (e.g., if sponsored by a local ministry unit, what is its contribution?) / $ / £ Yes £ No
Other United Church of Canada Support / $ / £ Yes £ No
Other Grants / $ / £ Yes £ No
Other Fundraising / $ / £ Yes £ No
Amount Requested from South West Presbytery (not to exceed $5,000) / $ / If this application is approved, what is the preferred payment?
£ Lump sum £ Quarterly
£ Other
Total Revenues / $

Major Expenses for the Initiative

$
$
$
Total Expenses / $

Proposed Plan Revisions, if funding is unavailable (250 words maximum)

Payee Information (for cheque, if grant is approved)

Name
Address
City & Postal Code

Part Five: Declaration of Intent

On behalf of the applicant(s), I declare that, if awarded a grant by South West Presbytery of The United Church of Canada, the organization named on the Grant Application Form shall use the funds awarded solely and explicitly for the purposes stated and in accordance with the statement of Initiative’s Revenues and Expenses (Part Three) as submitted and approved.

Any portion of the grant funds not used for the purposes stated in the Grant Application Form or any portion not required to complete the initiative or meet the objectives as described, will be returned to South West Presbytery of The United Church of Canada, unless prior written permission to vary the stated purposes is obtained from the Mission Support and Finance Committee of South West Presbytery.

Where this application is made by a local ministry unit (LMU), I declare that the following requirements have been met:

•  Submission of the LMU’s current annual report to South West Presbytery (SWP)

•  Submission of its Customer Service Standards for Accessibility Policy and Practices (AODA) to SWP

•  Submission of its Violence and Harassment Policy and Practices to SWP

•  Submission of its Health and Safety Training Policy and Practices to SWP

•  Compliance with the Assessment of Fees policy of SWP

•  Submission of its statistics for the previous calendar year to The United Church of Canada

•  Enrolment in the United Church’s national ADP payroll program

The conditions stated above have been reviewed and agreed upon by signing authorities for the organization named on the Grant Application Form.

Print Name of Signing Officer
Title of Signing Officer
Signature of Signing Officer
Signed at / Date

For the Use of South West Presbytery

Action by the Mission Support and Finance Committee, South West Presbytery

The foregoing application was duly considered at a meeting of the Mission Support and Finance Committee and the following recommendation will be made to Coordinating Council of South West Presbytery:

 Recommended  Recommended with changes  Deferred  Denied

Recommended changes:

Chair, Mission Support and Finance Committee Date

Action by Coordinating Council, South West Presbytery

The foregoing recommendation of the Mission and Support and Finance Committee was considered at a meeting of the Coordinating Council and the following recommendation will be made to South West Presbytery:

 Recommended  Recommended with changes  Deferred  Denied

Recommended changes:

Chair, Coordinating Council Date

Action by South West Presbytery

The foregoing recommendation of the Coordinating Council was considered at a plenary meeting of South West Presbytery and the following decision was made:

 Approved  Approved with changes  Deferred  Denied

Approved changes:

Secretary, South West Presbytery Date

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