REGION OF QUEENS MUNICIPALITY

GRANT APPLICATION

Name of Organization: ______

Mailing Address: ______

Contact Person: ______

Position in Organization: ______

Email address: ______

Telephone: (Bus.)______(Res.)______

Objectives and Purposes of Program:

______

______

______

______

Description: (include type of program, area served, number of people involved, location of program, duration of program, and volunteer involvement)

Type of Program: ______

Area Served: ______

Number of People Involvement: ______

Location of Program:______

GRANT APPLICATION

Program Duration: ______

Volunteer Involvement:______

Amount Requested: ______

Additional Comments in Support of Your Application:

______

______

______

______

Please ensure that you have attached a copy of a financial statement for your organization for the previous year and a budget for the upcoming fiscal period.

I certify that to the best of my knowledge, the information provided by me in this Grant Application form is accurate and complete and is endorsed by the organization that I represent.

Signature: ______

Name: (please print) ______

Date: ______

Phone Number: (Bus.)______(Res.)______

GRANT APPLICATION GUIDELINES

1. Each organization requesting funding will be required to submit a budget for the current fiscal period, as well as the previous year’s financial statement. The organization will be required to give an outline of the objective and purposes of their program.

2. Organizations will not be required, unless specifically requested, to make a presentation before the Committee of the Whole.

3. Grants will not be issued to organizations with a National or a

Provincial affiliation.

SUBMISSION DEADLINE IS May 3, 2013

Region of Queens Municipality

GRANTS TO ORGANIZATIONS

The Region of Queens Municipality is now accepting applications from Community Organizations for grants for the 2013/2014 fiscal year.

To qualify, organizations must be Queens County based, must submit a financial

statement for the previous year and a budget for the upcoming year. New organizations must submit a budget only.

Details and applications for funding are available from:

Address: Phone:

Heather Hurshman (902) 354-3453

Deputy Treasurer

Region of Queens Municipality

P.O. Box 1264

Liverpool, Nova Scotia

B0T 1K0

Application deadline is Friday, May 3, 2013

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