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MULTI-YEAR GRANT APPLICATION

Name of Organization:

NWT Societies Act Registration Number:

Mailing Address:

Contact Person:

Role/Title of Contact Person:

Phone Number of Contact Person:

Email Address of Contact Person:

Describe your organization.

Is your organization in good standing with the City of Yellowknife? (e.g. taxes, permits or outstanding grant reports) If not, please explain.

Is your organization in Yellowknife and serving the community of Yellowknife? If no, please explain.

Select the Funding Priority that applies to this application.

Explain how your programs and/or projects meet the criteria in the Grant Funding Policy.

Amount of funding your organization is requesting for each of three (3) years.

Provide all relevant information about your three (3) year plan and explain why it should be funded. Describing your program, project, service or event.

Who is your target audience and how many people are expected to attend?

What is the frequency of the program, project and/or event? (e.g. one time, weekly, or annually)

Where is the location of your program, project or event?

Is your program inclusive, accessible and affordable? Please explain.

What other partnering organizations are involved with this event? How are they involved?

How will the City of Yellowknife be recognized in the advertising and marketing of your event?

Please list all the members of the organization's Board of Directors (including name, position, address, phone number).

Corporate Registry Profile Report (proof that you are current with Societies)

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If successful, your organization must provide proof of Insurance with a minimum $2,000,000 in liability insurance. The City of Yellowknife must be listed as additional insurer on the policy.

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SAMPLE BUDGET - REVENUES

Revenues	Year 1	Year 2	Year 3
Ticket Sales	$44,000	$55,000	$60,000
Tour Revenue	$3,000	$3,000	$4,000
Fundraising Raffle	$30,000	$35,000	$40,000
Totals	$77,000	$93,000	$104,000

Three (3) Year Budget - Revenues. List revenues for Year 1, Year 2 and Year 3 with totals.

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SAMPLE BUDGET - EXPENDITURES

Expenditures	Year 1	Year 2	Year 3
Advertising	$8,000	$10,000	$12,000
Website	$1,000	$2,000	$2,000
Insurance	$3,000	$4,000	$4,000
Totals	$12,000	$16,000	$18,000

Three (3) Year Budget - Expenditures. List expenditures for Year 1, Year 2 and Year 3 with totals.

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Please attach your three(3) year Strategic Plan.

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Signed Financial Statements from your most recent Annual General Meeting (signed by TWO current board members). This must include an Income Statement (listing revenues and expenses) and a balance sheet (listing assets, liabilities and equity).

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Use of Funds

The Organization hereby agrees to use the funds or services provided to the Organization only in the manner set out in this application. The City of Yellowknife reserves the right to request, at any time, the return of any of those funds if the Organization uses the funds in a manner that, in the opinion of the City, is inconsistent with the objectives of the City of Yellowknife Grant Funding Policy or with the description of the intended use of the funds as set out in the application or should it be discovered that the undersigned made a material misrepresentatin in the application.

Privacy Policy

The City of Yellowknife is committed to protecting the privacy and confidentiality of personal information. All personal information that is collected by the City is used for the City fo Yellowknife Grant programs.

Representations

In making this application, we the undersigned board member(s)/Executive Director hereby represent to the City of Yellownife and declare that, to the best of our knowledge and belief, the information provided in this application and the related attached supporting documents are truthful and accurage and the application is made on behalf of the Organization and with the full knowledge and consent of the Board of Directors.

Executive Director or Board Member Signature

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