For office use:
COMMUNITIES 4 FAMILIES
Grant Application Form
Communities 4 Families (C4F) invites groups or organizations to apply for grants to support
programming for Downtown families with children aged 0-6. Programs for Downtown parents and
their children (aged 0-6), or parenting programs for parents with children ages 0-6, are eligible.
C4F grants are to support participants who reside within C4F boundaries. See FAQ’s for our map.
Incomplete applications will not be considered.
Group Information
Group / Organization Name
Contact’s Name
Contact’s Title or Job Position
Address
Postal Code
Phone #
Fax #
E-mail
Total Budget request
Make cheque payable to:
Is your group/organization provincially incorporated &/or a registered charity? Yes
No
If YES, please provide your incorporation or charity number:
If NO, please provide at least one (1) letter of support from an incorporated non-profit organization.
The letter of support must include the incorporation or charity number for the sponsoring
organization.
Please note: As a sponsoring organization you are responsible to ensure that the reporting forms
and receipts are submitted by the deadline. See page 5 of this application for information that must be
included by the sponsoring organization. The sponsoring organization may also apply for a grant.
However, their application will not be considered if the conditions for a group they sponsored are not
met.
Communities 4 Families Grant Application
Briefly describe your group/organization:
1
Letter of support attached: Yes
No
Name of sponsoring organization:
Incorporation or charity number of sponsoring organization:
Program Information
Please provide a brief summary of the program(s) to be funded.
When will your program(s) run?
Start date:
Start date:
End date:
End date:
*
* Final reports are due within 6 weeks of final program end date.
Who is this program intended for?
What percentage of the children in attendance do you expect to be aged 0-6?
How will parents and children interact in this program OR how will your program teach parents to
interact with their children aged 0-6?
How will you encourage participation? Please provide your outreach plan.
Briefly explain how you know this program is needed?
Who will be facilitating this program and have they had any related training?
If you have run this program recently, what was your average attendance (# children, # families)?
If this is a new program, what is your anticipated attendance per session?
Communities 4 Families Grant Application
Our expectation is that programs serve participants in the C4F boundaries. What percentage of your
participants will be residents of this area?
2
Please explain which of the Healthy Child Manitoba pillars (Positive Parenting, Nutrition and Physical
Health, Learning and Literacy) this program addresses and how?
Capacity Building is encouraged to be a part of any program which we support. In what way does the
program you intend to run include capacity building?
What program results do you hope to achieve to consider this a successful program? How will you
measure the success of your program?
Has your group applied for other funding for this program? Yes
No
If yes, please provide source of funding and amount received or requested.
Are other groups in partnership with you on this program? Yes
No
If yes, who and in what way are they supporting this program?
---------------------------Has your group / organization received funding from C4F in the past?
Yes
No
If yes, please provide the date and amount of the last funding:
Have all reporting requirements for that grant been met?
Yes
No
If the program is not yet complete, please give details (when will it end, how much funding
has been used already, how much will be used by the end of the program)
PLEASE NOTE – a budget will be approved and sent to you. Any changes to this approved budget
must be requested. Maximum requests:
 Facilitator Fees (up to $16/hour) – please include time for facilitators to attend facilitator
meetings - 2 hours 3 x a year per person.
 Child-minding (up to $12/hour)
 Healthy Snacks (up to $35/week)
 Program supplies (such as craft and activity supplies) (up to $20/week)
 Transportation for participants (up to $5/week)
If you have run this program in the past and found that your numbers have been very high, you are
welcome to request additional funding for snacks and supplies. Please note this on your budget form.
Communities 4 Families Grant Application
BUDGET INFORMATION: Please fill out accompanying budget form (one for each
program request)
3
Certification
We, the undersigned, certify that the information provided in this application is true and accurate to
the best of our knowledge. We further certify that we will provide C4F with receipts and reports as
required.
Name:
(Print)
Name:
(Print)
Title:
Title:
Phone Number:
Phone Number:
Signature: ____________________
Date:
Signature: ____________________
Date:
Checklist to ensure your documentation is complete:
Completed application
Proposed Budget(s) – one for each program
Signed Certification
Completed Parent Child Program Checklist
Communities 4 Families Grant Application
Sponsorship letter or incorporation number
4
Sponsoring Organizations ONLY
Sponsoring organizations may use the following form, or include this information on their own
letterhead:
_________________________ (Incorporation # /charitable # ____________)
Name of sponsoring organization
Agrees to sponsor _______________________________________________
Name of Applicant
for their _____________________________________________________
Name of Program
requesting the amount of $_____________________________.
As a sponsoring organization we understand and accept the responsibility to
ensure financial accountability: Receipts and reports will be submitted within 6
weeks of program completion (or a date mutually agreed between C4F and the
applicant)
_________________________________________
Sign
_________________________________________
Print name
_________________________________________
Address
_________________________________________
Date
Communities 4 Families Grant Application
_________________________________________
Job Title
5