Meet Your Street Claim Form

Reimbursement claim form for agreed Meet Your Street funding.

Please complete this form within 30 days after your event.

This form must be completed in one session.

Please ensure you have all necessary information and documentation ready before you begin, including:

proof of the bank account (any one of these: a deposit slip, a letter from the bank, or a bank statement showing the bank account number).

Receipts for reimbursement.

Photo/s of your Meet Your Street gathering.

If you encounter any issues with the application form, please contact: funding@selwyn.govt.nz.

Privacy Notice

Personal information collected through this form will be used to assess your grant application and will be handled in accordance with the Privacy Act 2020 and Selwyn District Council’s Privacy Policy [PDF, 6494 KB].

Contact Details:

Name of Street that the activity took place on:
Contact Name/s:
Address:
Postcode:
Email Address:
Phone Number:

Activity Details:

Activity:
What were the highlights or key outcomes of your street gathering? We’d love to hear how your event went — for example, any fun or memorable moments, new connections with neighbours, ideas or projects that came out of it, or ways it made your street or community feel more connected.
Number of participants:
Location of activity:
Date of activity:
What was the total spend? Overall Cost of Activity
Please give details of how the money was spent: Please give details of how the money was spent: For example - $80 towards arts supplies; $20 towards refreshments. Receipts are to be attached at the bottom of the form.

Bank Details:

Bank Account Name:
Bank Account Number:
Please upload a proof of the bank account: (Acceptable forms of bank verification include: stamped letter from the bank, pre-printed deposit slip, copy of a bank statement, screenshot from internet banking or online banking app. The bank name/logo, bank account name and account number must be clearly identified on the document.)

Supporting Documents:

Receipts At least one receipt is required for reimbursement.
Photos of Event As part of submitting your claim, Council also requires no less than one high resolution photo of the gathering.

Declaration:

Privacy Notice Personal information collected through this application will be handled in accordance with the Privacy Act 2020 and Selwyn District Council’s Privacy Policy.
I agree that the information provided in this form is correct.	Yes

Privacy statement

The personal information you provide in this form will be collected, held and protected by Selwyn District Council in accordance with our Privacy Policy and the Privacy Act 2020. Our Privacy Policy explains how we use and share personal information in relation to any interaction you have with Council, and how you can access or correct your information at any time.

You can read the full policy at selwyn.govt.nz/privacy.

We will use the email address you provide to send communications directly related to this form or application. By submitting this form, you consent to receive those communications by email. If you require a hard copy, please email ContactUs@selwyn.govt.nz, visit our Service Desk Team or call 0800 SELWYN (735 996).