Funding Application: PECSF 2017 – 2019 Funding Cycle
Completed funding applications: Email - [email protected]
Charity Name:
City and Region:
(One application per region)
Canada Revenue Agency
Charitable Registration Number:
Funding Application Contact:
Financial Contact:
Job Title / Role:
Contact Information:
(Mailing Address, telephone number,
email address)
Website Address:
Certification
*Please note: To be considered for funding, applicants must provide all of the following
information and confirm the name of two people with signing authority who approve your
organization’s intent to carry out the project described in this application. (E.g. CEO, Board
President, Director)
Name and Position
Name and Position
Date
Date
Please consider the reporting requirements and your organization’s capacity before applying.
Although the annual reports are not onerous, they are mandatory. Failure to provide the required
information each year by the deadline will affect the continuation of funding for the remainder of
the funding cycle and potentially for future funding cycles.
PECSF 2017 -19 Funding Cycle
Applications due June 15, 2017
Funding Application: PECSF 2017 – 2019 Funding Cycle
Preference will be given to organizations with a project/ program or service that:
 Aligns with organization’s mission and mandate, has 2 years of success
 Has staff expertise and involves volunteers
 Positively impacts 20+ people
 Adds regional value and is innovative
 Aids other organizations in region through its outcomes
 Involves external evaluation and performance measurement
 Requests less than 40% of total budget and is sustainable past 2019
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1. Purpose of Organization
Mission Statement, Vision, Values
Activities, programs and/or services delivered by your organization
Demographics of clientele and geographical area served
2.
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Structure of Organization (*Attach as separate document if necessary)
Organizational structure: board, staff, members, volunteers
List of current Board of Directors
PECSF 2017 -19 Funding Cycle
Applications due June 15, 2017
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3. Funding Request
Explain initiative (program, project or service)
Planned initiatives and staff requirements
Number of beneficiaries/reach/funding partners
Regional value-add
Timeline (planning, launch, implementation)
Goals and benchmarks for success/method of evaluation/means of recognizing PECSF
4. Financials
Proposed budget for PECSF supported project/program/service during the 2017-2019, threeyear funding cycle must include:
 Detailed EXPENSES including pro-rated future overhead costs (i.e. supply, material,
promotional, staffing & salary, benefits, honoraria, facilities, evaluation, etc.).
 REVENUE (cash and in-kind), showing potential and confirmed funds. Including volunteer
hours and associated value.
 Must clearly identify anticipated use of PECSF funds, indicate requested fund amount
within budget summary.
2017-2019 Fund Supported Pool Distribution Cycle
PECSF CAMPAIGN
DISBURSEMENTS
August 2018 – First Cheque
Campaign 2017
March 2019 – Second Cheque
August 2019 – First Cheque
Campaign 2018
Campaign 2019
March 2020 – Second Cheque
August 2020 – First Cheque
March 2021 – Second Cheque
PECSF 2017 -19 Funding Cycle
REPORTING
May 31, 2018First Progress Report Due
May 31, 2019 –
Second Progress Report Due
May 31, 2020 –
Third / Final Progress Report Due
Applications due June 15, 2017
In addition to providing the request program budget related information, please include a copy of
your organizations most recent Board approved financials.
Insert budget related information into template provided.
Organization’s current annual budget:
Expenses:
Detailed Item Description for
project/program
or service
Year One
Costs
Year Two
Costs
Year
Three
Costs
Amount
Requested
from PECSF
Amount
Requested
from Other
Funders
Total
Costs
Administrative Expenses:
Salaries:
Materials and Equipment:
Promotion and Marketing:
Honoraria:
Volunteer Training:
Employee Training:
Transportation:
Computer Leases and Software:
Facilities:
Program Evaluation:
Other:
Total Expenses:
PECSF 2017 -19 Funding Cycle
Applications due June 15, 2017
Revenue:
What annual amount of the project budget are you requesting from PECSF: $
Source of
Funding
Year One
(2017)
Cash
In-Kind
Confirmed
Year Two
(2018)
Potential
Cash
In-Kind
Confirmed
Year Three
(2019)
Potential
Cash
In-Kind
Confirmed
Potential
PECSF
Other:
Total
Expenses:
PECSF 2017 -19 Funding Cycle
Applications due June 15, 2017