Sport and Recreation Branch
Application for financial assistance - Regional project and Active Communities grant
Please consult our program guidelines at the following web site:
Or consult your regional consultant at :
Type or print clearly
- INFORMATION ABOUT YOUR ORGANIZATION
a)Official name or organization:
b)Name of applicant:
c)Complete mailing address of applicant :
Municipality: / Province: / Postal code:
d)Tel.: / e) Fax.: / f) Email:
g)Your organization is a :
Municipality
First Nation
RSC (regional service commission) / Sport
Recreation
Multi-Sport
Other
2. INFORMATION ON THE PROJECT
a)Name of project/activity:
b)Location of project/activity:
c)Is your program / project inclusive? If no, what is the specific target population?
Yes / No, please select double click to selectAboriginalPerson with a disabilityEconomically disadvantagedWomen/Girls
Aboriginal
Person with a disability
Economically disadvantaged
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) in the delivery of your project/activity.
Partner / Contact Person / Role/Qualification / In-kind contribution
(double click for selection)
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
Volunteer WorkEquipmentTransportationFacilitiesOther
f)What type of leadership training do your leaders 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
Aboriginal Coaching Module / Making Head Way
Physical Litteracy workshop / Official Training / Certification
Super Hero training / Other, specify:
g)Do your coaches/leaders require training? Yes No
If yes, please explain(Include date, cost, location, number of participants and type of training:
3.DETAILED PROJECT information
a)New project/activity Enhanced project/activity
b)Are you a PSO member? (provincial sport organization) Yes No N/A
c)Do you have liability insurance for this activity? Yes No
d)Date of project/activity: / Start date / End date:
dd/mm/yy / dd/mm/yy
e)Number of participants.
How many maleswill participate in this activity/project / How many females will participate in this activity/project / How many male volunteers will be involved in this activity/project / How many female volunteers will be involved in this activity/project
f)Describe your project and its anticipated results in clear and concise terms.
4.PROJECT BUDGET
Estimated revenues
Please list ALL project revenues / In-Kind / Cash / Estimated expenses
Please list ALL project expenses / Amount
Registrations / $ / $ / Equipment / $
Fundraising / $ / $ / Insurance / $
Sponsors / $ / $ / Administration / publicity / $
Other grants / $ / $ / Training – Board and officials / $
Honorariums / $ / $ / Honorarium / $
Facility / $ / $ / Adaptive equipment / $
Equipment / $ / $ / Facility rental / $
Volunteer / $ / $ / Physical activity / $
Other / $ / $ / Athlete Development / $
$ / $ / Competition / $
$ / $ / Coach training / $
$ / $ / LTAD Training / $
$ / $ / LTAD Equipment / $
$ / $ / LTAD Facility Rental / $
$ / $ / Other / $
Total / $ / Total$ / Total expenses / $
Total in-kind / $ / Amount requested from department
$
+Total Cash / $
-(minus) total expenses / $
= Total / $
Do you already have direct deposit? / Yes / No
5.Vendor Form (changes in regional organization)
Official name of organization:
Official address of organization
Date of last annual general meeting :
ELECTED MEMBERS / 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:
Date submitted: / Signature:
6.Applicant`s checklist
You have included LTAD documents? / Yes / No / n/a
Direct Deposit form is included? / Yes / No / n/a
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Eng. Application Form
Update: 2018/04/24