SPARKS 2014 Application WORD Format

PROJECTAPPLICATIONTOOL

AppendixA

call519661-5336ifyouhaveanyquestions.

‘SPARKS!NEIGHBOURHOODMATCHINGFUND’PROJECTAPPLICATION

PleasecompletethePROJECTAPPLICATIONandensurethatallsupportingdocumentsareattachedtotheapplication.Eachquestionhasanexpandingspaceforanswerssopleaseprovideasmuchinformationasyoufeelisrelevanttoyourrequest.Theapplicationmustbeforwardedbythe

Submissiondeadline: Friday, January 31,20144:30p.m.

Bymail:PauladeFreitas,AdministrativeAssistant.CityofLondon,MarketTower,151DundasSt.,3rdFloor,Suite303,London,ONN6A4L6;

Bye-mail:

APPLICANTINFORMATION

NameofProjectLead(residentneighbourhoodgroup) / Groupregistrationnumber
NotforProfitnumber: CharitableOrganizationnumber:
Notregistered
ProjectLeadDaytimeContactInformation(ProvideNameofContactperson,Address,Telephone,Fax,Email,WebsiteURL)
NameofApplicant(iftheprojectleadisnotregisteredthisgroupactsasthesponsoringregisteredorganization) / Groupregistrationnumber
NotforProfitnumber: CharitableOrganizationnumber:
ApplicantDaytimeContactInformation(ProvideNameofContactperson,Address,Telephone,Fax,Email,WebsiteURL)

‘NEIGHBOURHOODMATCHINGFUND’PROJECTDESCRIPTIONANDINFORMATION

NameofProject / Amountrequested:
Neighbourhoodthatisbeingimpactedbyproject(North-South-West-Eaststreetboundariesanddescriptionofneighbourhood)
Whatelectoralward(s)willtheprojecttakeplacein?(
In400wordsorless,describetheNeighbourhoodProject(noattachments):
Documenttheprojectgoalsandtheexpectedoutcomesfromtheproject(Outcomesarethechangesthathappenasadirectresultofyourproject.Thesechangescouldmakeadifferencetotheenvironment,tothecommunityortothepeoplewhobenefitfromtheproject.)
Howdidtheideafortheprojectcomeabout?Whowasinvolved?
Describethesupportfromtheneighbourhoodfortheproject.Beasspecificaspossible.Demonstratefar-reachinganddiversesupportfortheproject,ifpossible.
Howwillyourprojectoptimizeengagement,involvementandparticipationfromtheneighbourhood?
DescribehowyourprojectcontributestofulfillingtheLondonStrengtheningNeighbourhoodsvision(SeeSectionIIoftheGuidelines.)
Ifthisprojectistobecomeanannualactivityhowwillyoucontinuetofundit?
Willtherebeaphysical,culturalorenvironmentallegacythatiscreatedfromthisproject?

PROJECTPLANNING

Isyourprojecton(ifyoudonotknowpleaseverifybycontactingtheCityofLondonPlanningDivisionat519661-4980)
Privateproperty with openpublicaccessPublicproperty
IfyourprojectsisonpublicpropertyhaveyouconsultedCityofLondonregardingimplementationi.e.:Planning,EnvironmentalServicesetc.
NoYes-pleaseprovidebelowwhomyouspokewith,thedateandwhatdetailswerediscussed:
Ifyouareplanningaprojectthatinvolvesconstructionorlandscaping(ie:installingsigns,structures,gardensetc.)pleaseattachamapidentifyingtheworktobedone, includingstreetnamesandcurrentstructures. Mapincluded
Ifyouareplanningaprojectthatrequiresongoingmaintenance(ie:gardens,communityboardetc.)howwillthismaintenancebedoneandwhowillmanageit?

DoestheProjectLeadorApplicantcurrentlyhave3rdPartyLiabilityInsuranceofatleast$2million?Ifyourprojectisfundedwrittenevidenceofinsurancewillberequired.(Pleasecheckone.)

ProjectLead:

currentlyholds3rdPartyLiabilityInsuranceofatleast$2millionorwillobtain3rdPartyLiabilityInsurancetocurrentinsurance

Applicant(sponsoringorganization):

currentlyholds3rdPartyLiabilityInsuranceofatleast$2millionorwillobtain3rdPartyLiabilityInsurancetocurrentinsurance

Ifyoudonothave3rdPartyLiabilityInsurance,identifythecostofobtainingtheinsuranceinyourprojectexpenses.

DECLARATION:Insigningthisapplication,Icertifythat:

I/Wehavereadandagreetoallofthetermsandconditionsoutlinedinthisapplicationform.

I/Werepresentthegroupnamedintheapplicationand,tothebestofmy/ourknowledge;theinformationprovidedhereinistrue.

I/Wewillcarryouttheactivitieswhenandasdescribedintheapplication.Weunderstandthatiftherearesignificantchangestoourinitiativeand/orifwefailtocarrythroughwiththisinitiativewemayberequiredtoreturnthefundstotheCityofLondonandthatitisourresponsibility,astheapplicant,tonotifytheCityofLondonofsuchchanges.

I/WeagreethattheCityofLondonisnotresponsibleforlossordamagetosupportmaterials.

Note:If‘submittingbye-mail’,I/Wecertifytheabove.

ApplicantSignature:

(TobesignedbyRegisteredNot-For-ProfitOrganization)

Date

Pleaseensureyouhavecompletedthefollowingrequireddocuments:

1)BudgetWorksheet(pages4and5)

2)LettersofSupport(attachtothisapplicationpackage)

3)ProjectMap(ifapplicable,attachtothisapplicationpackage).

PARTONE:ProjectExpenses-Pleaselistallitemsthatmustbepaidforinordertocompleteyourproject.DefinitionsareattachedintheInstructions.

A.SPARKSFundedExpenses(Expensescannotexceed$5,000) / Value($)
TotalSPARKSFundedExpenses: / 0
B.OtherProjectExpenses / Value($)
TotalOtherProjectExpenses: / 0
TOTALPROJECTEXPENSES
GrandTotal-A.SPARKSFundedExpenses+B.OtherProjectExpenses / 0

PARTTWO:Resources-Pleaselistallresources,includingin-kinddonations,volunteerlabour,donatedprofessionalservicesandcash.Definitionsareattachedintheinstructions.

A.In-KindDonations / Source / Value($)
TotalIn-KindDonations: / 0
B.VolunteerLabour / TotalHours / Value($)
ProjectPlanningMeetings
ProjectImplementation
Workshops
Other-Pleasedescribe:
TotalVolunteerLabour: / 0 / 0
C.DonatedProfessionalServicesie.:websitedevelopment,photography,graphicdesignetc.Aletterofdonationonletterheadmustbeprovided. / TotalHours / Value($)
TotalDonatedProfessionalServices: / 0 / 0

Page4of5

D. Cash SupportValue($)
TotalCashSupport: / 0
VALUEMATCH(DoNOTincludePARTONEProjectExpenses)
MatchTotal-PARTTWOA.In-KindDonations+B.VolunteerLabour+C.Donated
ProfessionalServices+D.CashSupport: / 0
AMOUNTREQUESTED:
FundingamountrequestedfromSPARKS!: (amountcannotexceedtheMatchTotalor$5,000)

After completion of this application template, please email your completed application to

Page5of5