- ILT Foundation

Your Organisation's Details

Name of Applicant Organisation(Required)

Organisation Address(Required)

Street Address City ZIP / Postal Code

Phone(Required)

Email(Required)

Contacts

Please supply two contact names from your organisation with job roles and cellphone.

Contact Name(Required)

First Last

Phone Number(Required)

Role(Required)

Contact Name(Required)

First Last

Phone Number(Required)

Role(Required)

About the Grant

Please select the type of application:

Scholarship or Umbrella funding - tell us about it?

Total Amount Requested from ILT Foundation in words(Required)

Dollar Amount $(Required)

What is the grant to be used for?(Required)

Please be specific about the detailed use of the grant.

Please feel free to add extra information if required.

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 8 MB.

Date of Event: (if applicable)

Please note: Retrospective funding cannot be provided for purchases / timing of event prior to application approval date.

How many people would benefit from this grant?

Please note number and explain how you calculated this.

Please provide a minimum of three outcomes / benefits to the community that would be provided by this funding.

#1.(Required)

#2.(Required)

#3.(Required)

Please note that an application can not be submitted without a minimum of 3 benefits being entered. If you need assistance with this aspect – please contact one of our team on 03 211 3750. If you would like to add additional benefits / outcomes – please send as a separate document.

Please describe how each benefit or outcome can be measured and / or established as being achieved.

#1.(Required)

#2.(Required)

#3.(Required)

Is funding required for wages?

Yes

Please list name of employee & role, their annual salary and the total requested amount.

For example: Joe Bloggs, Coach. Salary - $50,000. Total Requested: $10,000.

About Your Organisation

What is the legal status of your organisation?(Required)

What is the purpose of your organisation?(Required)

How many people belong to the organisation applying?(Required)

Please explain how you have calculated this.

Does your organisation work with children?(Required)

Yes

Do you have a Child Protection Policy?(Required)

Yes

Is your organisation registered with the Charities Commission?(Required)

(refer https://register.charities.govt.nz/CharitiesRegister/Search)

Yes

Are you GST registered?(Required)

If GST registered funding will not include any GST.

Yes

GST no:

What is your NZ Business Number?

(refer http://www.nzbn.govt.nz/mynzbn/search)

Financial Details

Please attach a copy of the organisation's approved budget (income & outgoings) for the coming 12 months. If funding is for a specific event, please also attach a separate event budget.

Drop files here or

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.

Please attach a copy of the organisation's most recent Financial Statements

Drop files here or

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.

If your application is for a one off project or event, please also attach two quotes for costings.

Drop files here or

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB, Max. files: 4.

Please attach details on fundraising you have done or intend to do, towards the funding applied for.

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.

Has the organisation applied for, or received funds, in the last 12 months from any other source? i.e. CTS, ICC, Lotteries, MSD, MBIE, Government Wage Subsidy, Sponsorships(Required)

Yes

Please select any other sources you have applied to:

CTS

ICC

Lotteries

MSD

MBIE

Government Wage Subsidy

Sponsorships

Other

Please give full details including funding organisation and amount applied for:

Please include where the money was received from, the purpose it was given for and the amount. For example: Grant received - Lotteries NZ, purpose - Team Uniforms. Amount $500.

Please attach a copy of the applicant organisation resolution to apply for funding to ILT Foundation.

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 8 MB.

This must be certified as true and correct by the secretary of the organisation, e.g. Committee minutes/resolution.

Declaration

Declaration / Consent of Audit / Accountability

We declare the information provided in this grant application is true and correct, to the best of our knowledge, and we have the authority to make the application on behalf of the applicant organisation.
This organisation fully understands that any and all grant monies received from the ILT Foundation can only be used for the purpose for which the grant was approved. Copies of invoices, receipts, and bank statements (where applicable), along with any unspent funds, will be returned to the ILT Foundation after the funds have been applied towards the purpose for which the grant was made.
We agree to comply with a request from an officer of the Department of Internal Affairs for additional information in relation to how the monies received have been spent. This may involve an audit or inspection of the books and/or accounts of your organisation.
We authorise the ILT Foundation to retain information pertaining to this application and to disclose that information as deemed necessary by the ILT Foundation for any purpose, including the publication of grants information.
We have read, understand, and accept all the conditions applicable to this application for a grant. The funds will only be used for the purpose applied for in this application.

If you are unable to provide the second signature at the time of application, please contact one of our team on 03 211 3750.

Agreement(Required)

I have read the above declaration and understand the conditions of this application

If you are unable to provide the second signature at the time of application, please click on the Save and Continue Later button below to generate a URL.

Copy and send this URL to the second person for them to sign and complete the form.

Name(Required)

Position(Required)

Signature(Required)

Please use your mouse to sign in the signature box above.

Signature(Required)

Please use your mouse to sign in the signature box above.

If you are unable to provide the second signature at the time of application, please click on the Save and Continue Later button below to generate a URL.

Copy and send this URL to the second person for them to sign and complete the form.

Bank Details

Branch(Required)

Applicant Organisation's Bank(Required)

Account Number(Required)

Name of Account(Required)

Personal account are not permitted.

Verification of your bank account details is required. Please upload an image of your bank deposit slip confirming the bank account details or an image of the Bank account header showing your organisations bank and account number.(Required)

Accepted file types: gif, jpg, jpeg, png, pdf, doc, docx, xls, xlsx, Max. file size: 2 MB.