Grant Application

Administration

Organisation name: *

CC Registration number: *

Address *

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Contact Person *

First name

Last name

Contact Number *

Email address *

Confirm Email address

Web Address

Bank account number *

Please ensure the accuracy of your information, and apply the following format e.g. XX-XXXX-XXXXXXX-XXX

Grant amount requested *

Organisation Description

Mission statement *

Or provide a brief description of the purpose and objectives of your organisation. *This information may be used by CGF to promote your organisation's profile.

Services *

Briefly state the specific services or programmes your organisation provides.

Number of paid workers *

Number of volunteers *

Including board members.

Number of people who benefited from your organisation last year (estimate) in the region you operate.. *

Estimation to include family and/or friends support of clients. Please do not use NZ-wide statistics.

Geographical area *

List the areas your organisation covers (cities, towns etc.).

Annual expenses for past year

Annual Income for past year

Grant Description

Grant purpose *

What will funds specifically be used for?

Grant outcomes *

Describe how the effectiveness of the funded project will be measured.

Other funding groups approached *

List other Funding Groups approached for same purpose (names, amounts).

Anticipated income/expense variations *

List any major new sources of income/expense anticipated in coming year

Other Funding

Previous grants received from CGF

List date and amount received

Has your organisation received or applied for funding from The Tindall Foundation in previous 12 months? *

Yes

Additional documents

Please scan the following documents and email them directly to admin@commongood.org.nz

Type the subject line of your email as follows:
"(your organisation's name) grant documents"

Annual financial statements and Audit or Review statement *

Professionally prepared annual financial statements and Audit or Review statement for the most recent financial year

Scanned bank deposit slip *

A scanned copy of your organisation's bank deposit slip, statement header or certified certificate is required as verification.

Additional documentation

In support of your application if necessary; not mandatory

Declaration

I declare the information supplied to be a true and accurate view of the applicant organisation at the time of signing. I have the authority to apply for funding on behalf of this organisation and do so in the knowledge that any funds received from CGF may be requested to be returned should this information be incorrect; the grant used for unspecified purposes; closure of the recipient organisation or the project funded is incomplete within the time specified.
If our application is successful we agree to promote our partnership with CGF where appropriate. We also give permission for CGF to promote our organisation’s profile if required.

Agree *