Discretionary Funding Application Form

Make an application for Council and Community Boards' Discretionary Funding

This form is to be used for all grant and loan applications to the Council or Community Boards. Information about grants is found on the Funding page.

* = required fields

Your Details

Name of organisation/applicant applying for grant *

Contact person *

Residential Address *

Postal Address (if different)

Phone Day *

Phone Night *

Email *

Please give the names and telephone contracts for one or two referees who can help us if the Assessment Committee requires more information:

Ref#1 Name *

Ref#1 Phone (day) *

Ref#1 Phone (night) *

Ref#2 Name

Ref#2 Phone (day)

Ref#2 Phone (night)

If an Organisation:

How many members does your organisation serve?

Financial members

Non-Financial members

Total members

Club sub/levies ($)

Is your organisation a legally constituted society or trust?

Yes
No

If you are registered for GST, please supply your tax number.

Our preferred method of payment is direct credit.

If a School:

Applications from schools should be approved or submitted by the PTA as a fundraising project rather than an educational project.

Has the PTA and/or Board of Trustees approved this application for funding?

Yes
No

The Funding Request

Purpose of funding * (what these funds will be used for)

Dates of Travel/Event:

From *

To *

Number of persons attending (if group)

Do you require a grant? *

(this does not have to be repaid)

Do you require an advance/loan? *

(this advance/loan is repayable to the Council)
A loan or advance is most appropriate where your organisation requires funding for the initial costs of your event/activity/project but revenue from the event etc will allow you to repay the advance/loan to the Council.

Total project costs (* - at least ONE required)

Eg materials, venue hire, promotion, equipment hire, personnel costs	Amount







(A) Total cost *

Upload copies of your quotes here (* - at least ONE required ). You may upload up to three files, Word or PDF, of up to 5mb each.

Fundraising to date: (* - at least ONE required)

Eg detailed fundraising, user fees, sponsorship	Amount







(A) Total cost *

Project Cost and Funding Summary

A. Total cost of project *
B. Less total funds available *
C. Difference *
D. Amount requested *

If you have received any financial assistance from the Selwyn District Council, Local Recreation and Sports Scheme, any Government Department, Lottery Board, QEII Arts Council, Trust or Society in the last three years please give details.

Year	To Whom Applied	Project Amount

How will this project benefit you/your group, or the Selwyn community? *
(max 900 characters)

Are you applying for multiple team members?
Please provide names and addresses of members resident in the Selwyn District.
(max 900 characters)

Please add anything else you wish that may aid your case for a grant/advance/loan for this project:
(max 900 characters)

Optional File Uploads

You may attach up to four files, of up to 2mb in size each, to support your application. Files must be Word, Excel, PDF, text or image format. You may alternatively email your files to funding@selwyn.govt.nz or post paper copies to the address below.

To assist your organisation in obtaining grant funding, you are welcome to contact any of the Councillors or Malvern Community Board Members. Please refer to Community Board for contact information.

Our preferred method of payment is direct credit. Please provide your bank account number (15 digits) and post or email a deposit slip to the address below.

Bank account number *

Particulars to appear on your bank statement: SELWYN D C

Post/email your deposit form and any other supporting documentation to:

Selwyn District Council
PO Box 90
ROLLESTON 7643
email: funding@selwyn.govt.nz

Checklist

Have you sent us your latest audited accounts (if an organisation)?
Do your figures add up?
Can your contact people be easily reached?
Have you listed the applicable dates (if relevant)?
Have you listed what fundraising you have completed to date?
Have you answered all the questions?

Final Details

I hereby declare that the above information is correct. If the application is successful, my organisation agrees to provide a certificate (which will be sent to me in due course by the local authority) stating that the money received has been spent or is being held in trust for the purpose stated.

Signed (print name): *
Designation: *
Organisation: *
Date of Application: *

Any enquiries, phone (03) 347-2800 or (03) 318-8338 or email funding@selwyn.govt.nz

Applications must be received at least 7 working days before meetings

Malvern Community Board meet the 4th Monday of the month
Springs, Ellesmere, and Selwyn Central Discretionary Fund Committees meet on the second Wednesday of each month, excluding January, prior to the regular Council meeting

Late applications will be held over until the next meeting.

Retrospective applications are not considered.

Check before submitting: Are your files attached? If you received any submission errors, you will need to re-attach your files.