Commemorating Waitangi Day Fund Application Form
Print out the form from this page, or you can download an application form as a Word Document (94k) or as a pdf document (306k)
- Applications close at 5pm, 11 September 2009. Applications postmarked on this date will be accepted the following Monday. Please do not fax applications.
- Please print clearly. Please do not use folders or binders to present your application as it will need to be photocopied.
- All sections of the application form must be completed. Incomplete applications will not be considered for funding.
- HELP? If you have any questions about the Fund, please contact the Ministry for Culture and Heritage on (04) 499 4229 or email waitangi.fund@mch.govt.nz. The Information Sheet also has some helpful tips on how to complete this form.
Section A: Overview
A1. Name of your organisation - if you have a registered name, please use this
A2. Contact Details
Organisation's postal address
Organisation's physical address - if different from above
Phone:
Fax:
Email:
Contact People
Name of Main Contact:
Position - if applicable:
Daytime phone number:
Fax:
Email:
Name of Second Contact:
Position - if applicable:
Daytime phone number:
Fax:
Email:
A3. Is this the first time you have applied to the Commemorating Waitangi Day Fund? Y / N
Year of last application:
A4. Are you are a recognised entity? Y / N
Please enclose proof of entity status (ONE of the following: current constitution or trust deed and certificate of incorporation, letter from your District Māori Council/appropriate iwi authority, copy of a Māori Land Court Order, bank account details, proof of organisational structure and/or copies of minutes of meetings/ annual general meetings).
A5. Is more than one organisation involved with this application? Y / N
if yes, please list names of other organisations involved:
A6. Are you GST registered? Y/ N
Section B: Event
B1.a Please give a brief outline of the proposed event to commemorate Waitangi Day in your community.
B1.b Show how your event relates to the criteria of the Fund- see www.mch.govt.nz or info sheet
Please include a detailed account of your proposed event on separate paper (no more than one typed A4 page)
B2. Who in your community/region, is this event aimed at?
B3. When will the event take place?
B4. Where will the event be held?
Section C: Event Management and Costs
C1. How much will your event cost in total?
$
Please enclose proposed budget for the event. Where possible, please attach copies of quotes and price lists.
C2. How much are you applying for?
$
C3. Please list, in order of priority, the most important items that require funding. Please do not include the cost of voluntary labour:
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| $ | |
| $ | |
| $ | |
| $ | |
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| $ |
C4. Have you received funding or applied for funding from any other sources? Y /N
If yes, please name the sources and the amount of funding and indicate whether that funding has been approved:
| $ | |
| $ | |
| $ | |
| $ | |
| $ |
Section D: External Support
D1. Please enclose two letters of community or official support of the event. The letters should be current and specific to the event.
D2. Please comment on the relationship the external sources have with your organisation and event.
Section E: Personal Information Notice
Information about applications provided to the Ministry for Culture and Heritage will be held by the Chief Executive for the purpose of permitting the Ministry to assess and evaluate the application, and to administer the grant.
Information supplied may be passed onto other relevant agencies to assist with the evaluation of the proposal.
Names of the grant recipients and the amounts will be made public. This information will be published on the Ministry’s website and may be published elsewhere from time to time.
Each applicant consents to the use and disclosure of their personal and other information in the manner as described above. If requested information with respect to the applicant is not supplied, the application may be declined for consideration.
Applicants and those who support the event may, under the Privacy Act 1993, request access to and correction of their personal information by the Ministry. These requests must be in writing.
The Chief Executive is subject to the Official Information Act and may be required to release information in terms of that Act.
Section F: Declaration
This declaration must be signed by at least two people. One signatory must be either the Director, Chief Executive or Trustee of the organisation.
The details we have given in all sections of the application are true and correct to the best of our knowledge. We have authority to commit our organisation to this application and we understand and will meet the requirements of this Fund. In signing this form, and if this application is successful, we agree to provide the Ministry for Culture and Heritage with an evaluation and expenditure report ONE month after the event.
Person completing this form
Name:
Signature:
Position:
Date:
Director, Chief Executive or Trustee
Name:
Signature:
Position:
Date:
Section G: Attachments
Please check that you have included the following documents with this application:
- Proof of entity status. ONE of the following: current constitution or trust deed and certificate of
Incorporation; letter from your District Māori Council/appropriate iwi authority; copy of a Māori
Land Court Order; bank account details; proof of organisational structure; and/or copies of
minutes of meetings/ annual general meetings. (Section A4) - Detailed account of your event and how it relates to the criteria. To be no more one typed A4 page. (Section B1)
- Proposed budget for the event (Section C1)
- At least two letters of support. Letters to be current and specific to the event. (Section D1)
Please send your application to:
Commemorating Waitangi Day Fund
Ministry for Culture and Heritage, Te Manatu
Taonga
PO Box 5364
WELLINGTON
or courier to:
Commemorating Waitangi Day Fund
Ministry for Culture and Heritage, Te Manatu Taonga
Level 5, Radio New Zealand House
155 The Terrace
WELLINGTON
Receipt of Application - Commemorating Waitangi Day Fund
Please fill in your name and address so we can let you know that your application has been received by the Ministry for Culture and Heritage.
You will be notified of the outcome of your application by mid-December
Name and Address:
Date Received: