CITY OF HAMILTON

NEIGHBOURHOOD ENGAGEMENT MATCHING GRANT PROGRAM

2017APPLICATION FORM

APPLICANTINFORMATION

Group Name/Resident Lead:
Would you describe your group as: (check  one)
 Informal Group (not registered as a non-profit organization)
(Informal Groups can only request funds up to $500.00. If your request is
more than that, you will need to identify a financial sponsor)
 Neighbourhood Community Association
 Not-for-Profit Corporation
Name of Financial Sponsor for Informal Group (if applicable)
Activity/Project Lead/Fiscal Sponsor contact Information:
Address: / Phone #: / e-mail: / Website/facebook/twitter:

ACTIVITY/PROJECT INFORMATION

Amount being requested:

When will this activity/event take place?[1]

Under which one of the following areas will this activity/project fit?

 Changing Spaces:Activities/events with the primary focus to renew or revitalize neighbourhood public and green spaces, contributing to neighbourhood pride, improving safety, or to enhance quality of life.

 Building Community:Activities/events that foster neighbourhood pride or build stronger relationships between neighbours/neighbourhood groups.

 Building Capacity:Projects or Activities that are not advocacy based but seek to empower neighbourhoods to be more actively involved in organizing, identifying, and coordinating around neighbourhood issues.

NEIGHBOURHOOD ENGAGEMENT MATCHING GRANT PROGRAM

2017APPLICATION FORM

Description of the activity/project: (400 words)If applying under Changing Spaces please include a photo of the area where the project will take place.

Please tell us in which neighbourhood this activity/even will take place. Do you have permission to do this activity/event?

3. CITIZEN ENGAGEMENT

Identify who will be involved in the project and the roles they will have (i.e. who will be your partners, do you plan on working with any local groups in the neighbourhood? How do you plan on involving local residents in the planning and carrying out of your activity/event? (400 words)

Describe the support from the neighbourhood for the project. Be as specific as possible.

Please project the following numbers?

# of people involved in planning this activity or project
# of people who might participate in the activity or project

4. EVALUATION

What do you want to achieve by doing this activity/event? How will you know if you have been successful?

5. BUDGET: EXPENSES AND RESOURCES

How much will your activity/event cost?

Estimated Expense Item / Source / $ Expenses
$
$
$
$
$
A. TOTAL ACTIVITY/EVENT COSTS / $
What will the Neighbourhood Engagement Matching Grant Funding be used to fund?

What Resources Do You Have for This Activity/Event?

Estimated Donated Resources / Source / $ Value
B. Donated Materials, Supplies and Professional Services / Identify / $
$
$
$
B. TOTAL DONATED RESOURCES / $
Estimated Donated Materials etc. / Hours / $ Value
C. Volunteer Labour / Number / Calculate at $20/hour
Project/Event Planning / $
Project/Event Implementation / $
Other / $
Total Volunteer Labour / $
C. TOTAL VOLUNTEER RESOURCES / $
Estimated Cash Resources / Source / $ Value
D. Cash Support / Identify / Amount
$
$
D. TOTAL CASH RESOURCES / $
APPLICANT SIGN OFF
By submitting this Application, I acknowledge and agree to the following:
I/We represent the group named in the application and, to the best of my/our knowledge, the information provided in this Application is true.
I/We will carry out the activity/event when and as described in the Application. I/We understand that if there are significant changes to the activity/event and/or I/we fail to carry through with theactivity/event, I/we may be required to return the NEMGP funds back to the City of Hamilton, and it is my/our responsibility as the applicant to notify the City of Hamilton of any changes.
I/We acknowledge that the submission of this Application does not guarantee funds will be awarded for theactivity/event.
I/We assume all liability for the activity/event.
I/We hereby release the City of Hamilton and its councilors and employees from any and all liability for any loss or injury sustained by me/us, regardless of how caused, resulting from the activity/event.
I/We agree to indemnify and hold harmless the City of Hamilton and its councillors and employees against any liability, damage, loss, claims or demands and actions of any nature whatsoever, including solicitors fees, which arise out of or are in any way connected with the activity/event.
If the activity/event takes place on City property, I/we agree to comply with all guidelines and requirements of the City of Hamilton respecting use of City property, including those of the Special Event Advisory Team (SEAT).
If I/we receive NEMGP funds from the City of Hamilton, I/we will submit a final report summarizing the activity/event and objectives achieved and final budget. Failure to submit a final report may affect eligibility for future applications.
If I/we receive NEMGP funds from the City of Hamilton, I/we will submit receipts of expenses for the activity/event, upon request by the City of Hamilton. Failure to submit receipts may affect eligibility for future applications. Please note that any outstanding monies not spent must be reimbursed back to the City of Hamilton.
If I/we receive NEMGP funds from the City of Hamilton, I/we will submit a final report summarizing the activity/event and objectives achieved and final budget.
If I/we receive NEMGP funds from the City of Hamilton, I/we will submit receipts of expenses for the activity/event, upon request by the City of Hamilton.
I/We hereby give permission to the City of Hamilton to share my/our name(s) and details of this Application to outside organizations and various City departments for the purpose of determining if I/we have received or are or may be receiving funds from those organizations or departments for the activity/event. I/We hereby give permission to those outside organizations to share such information with the City of Hamilton.
I/We hereby give permission to the City of Hamilton to share my/our name(s) and nature of the activity/event with Council, and I/we acknowledge that such information will become a matter for the public record.
I/We acknowledge that information contained in this Application is subject to disclosure under the Municipal Freedom of Information and Protection of Privacy Act.
I/We agree to acknowledge receipt of funds from the Neighbourhood Engagement Matching Grant Program from the City of Hamilton on all promotional material for our activity/event if our application is approved.

Date:

Applicant Group/Resident Lead Name:

Signature(s):

Where there is a Financial Sponsor for an Informal Group, also complete the following:

I/We agree to be bound by the same terms and conditions as set out under the Applicant Sign Off.

Financial Sponsor Name:

Signature(s):

Personal information contained in this Application is collected pursuant to section 107 of the Municipal Act, 2001, and will be used for the purpose of administering the Neighbourhood Engagement Matching Grant Program and for statistical and reporting purposes. Questions about this collection should be directed to Carmen Rachelle Bian, Community Services, (905) 546-2424 ext 2187 or .

[1] Please ensure you do not submit an application where your event/activity takes place during the four week adjudication period that takes place from the NEMGP submission dates.