Municipal Funding Application

The Applicant

Applicant name:

Mailing address:

Contact name:

Contact phone:

Contact e-mail address:

The Project

Name:

Project date:

Project in the area of: (please check appropriate box) (please attach a detailed project description)

Social & Community Services

Seniors or Youth

Historical, Arts & Cultural Events or Organizations

Fundraiser for Municipal Projects

Fundraiser for Community Organizations or Programs

Community Beautification

Protection/Preservation of the Environment

Disaster Relief

Event Sponsorship

Detailed project description

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Details

Please provide a brief description of the project/operations:

Please describe how your project/operations enhance and enrich our community:

Do you provide grants/bursaries to other organizations or individuals?

Yes

No

Financial

Funding requested:

Have you ever received Municipal funding in the past?

Yes

No

If applicable, please describe the fundraising initiatives that will be undertaken in order to complete funding requirements:

Municipal Facility - Request to Waive Rental Fees

If you need more space for this section, please attach your timetable at the bottom of the form.

REMINDER: This is not a booking. You are still required to book the facility.

Facility:

Room:

Date:

Time:

Additional information:

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Verification

The undersigned verifies that the information provided in this application is correct and complete.

Signature:

Clear

Date:

Name:

All information submitted to the Municipality of Northern Bruce Peninsula is being collected under the authority of the Municipal Act and subject to disclosure under the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Questions about this collection of information should be directed to the Clerk at (519) 793-3522 ext. 236 or via email to clerk@northernbruce.ca.

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