Please complete all questions with relevant information. Refrain from writing more than the word limits,
where specified. Do not write ‘see attached’ in place of a response.
Section 1: Your Organisation
1.1
Your organisation’s name:
1.2
Physical address:
1.3
Postal address (if different from above):
1.4
Contact person (including email and phone number):
1.5
Key people in your organisation (name and role):
Name
Role
1.6
Are you a registered charity? If so, what is your Charities Commission registration number?
1.7
When was your organisation established?
2017 Application Form | Page 1
1.8
Are you GST registered? If so, please provide GST number
1.9
Tell us about the focus and purpose of your organisation (maximum 50 words)
1.10 Number of paid and volunteer staff
Paid:
Volunteer:
1.11 In general, where does your organisation get funding from?
1.12 In round figures, what is your annual expenditure?
Section 2: The Project/Programme
2.1
Please give a description of the project or purpose for which funding is sought (maximum 150 words)
Your answer should include a description of your planned activities, your typical client/beneficiary
(demographic) and the approximate number of people you hope to reach. Information about need
and intended outcomes can be included in Section 3.
2017 Application Form | Page 2
2.2
What evidence is there that this project/programme is needed?
Please describe how you know there is a need for your project – this could be through research data,
community consultation or evidence of current demand for services.
2.3
What is the timing of your project - when will it commence and when will it conclude?
Section 3: Outcomes
Your project outcomes should clearly align with the SKYCITY Auckland Community Trust’s vision:
‘Supporting families to thrive and communities prosper’. The priority outcomes that the SKYCITY Auckland
Community Trust is looking to achieve under this vision are described below:
Impact Streams
Priority Outcomes
Financial capability
for families
Families are financially confident, independent and can mitigate debt
and debt-causing behaviours.
Employment and
economic prosperity
for families
Families can generate their own income through the attainment and/or
enhancement of work-related skills and training, enterprise and access
to work.
Pathways to
employment and
economic prosperity
Healthy and
stable families
Young people are supported to thrive at every stage of their
development towards a successful and prosperous adulthood.
Children, young people and families have access to education, are
supported in educational pathways and achieve educational success.
Families develop attitudes, behaviours and skills that play a positive
role in improving their health, safety and resilience.
2017 Application Form | Page 3
3.1
Please use the table below to describe the intended outcomes and long-term impact of your project or
programme as relevant to one or more of the SKYCITY Auckland Community Trust’s impact streams.
SKYCITY Auckland
Community Trust’s
Impact Stream
What will change for families or communities as a result of your project?
Immediate Outcomes
(maximum 50 words)
Long-term Impact
(maximum 50 words)
Financial capability
for families
Employment and
economic prosperity
for families
Pathways to
employment and
economic prosperity
Healthy and stable
families
2017 Application Form | Page 4
Section 4: Evaluating impact
If your application is over $50,000, please complete the SKYCITY Auckland Community Trust’s evaluation plan
template and skip Section 4. If you application is under $50,000, please answer all of the questions in Section 4.
4.1
What aspect/s of your project or programme do you plan to evaluate? (maximum 100 words)
4.2
What evaluation tools might you use to carry out your chosen evaluation? (maximum 100 words)
4.3
How do you plan to resource this evaluation? (maximum 100 words)
2017 Application Form | Page 5
4.4
If your application to the SKYCITY Auckland Community Trust includes evaluation expenses, what is
the purpose of your evaluation and how will SKYCITY Auckland Community Trust funding enable your
organisation to achieve this purpose? (maximum 300 words)
Section 5: Collaboration
5.1
Is your project or programme collaborative?
Yes* – go to section 5.2
No – go to section 5.3
* A collaborative project/programme is defined by the SKYCITY Auckland Community Trust as being
co-led by one or more organisations, with a formally recognised partnership (eg Memorandum of
Understanding (MOU)), a common vision and shared resourcing – with the intention of achieving
greater impact.
5.2
If you answered ‘yes’ to section 5.1, please explain:
• The nature of this collaboration
• How SKYCITY Auckland Community Trust funding would be managed across the collaborative partners
• How the collaboration enables the project or programme to better achieve its intended outcomes
detailed in Section 3.
2017 Application Form | Page 6
5.3
If you answered ‘no’ to question 5.1, please give a brief outline of any active relationship that your
organisation has with others that benefit your project or programme:
Section 6: Project Funding
6.1
How much money is your organisation requesting from SKYCITY Auckland Community Trust?
This should be GST exclusive if your organisation is GST registered; GST inclusive if your organisation
is not GST registered
$
6.2
For this funding request detail separately the elements of expenditure.
• This should total the amount of your request
• GST exclusive if organisation is GST registered, GST inclusive if not GST registered
$
$
$
$
$
$
$
$
Total (should equal section 6.1)
6.3
$
How much money has your organisation already raised for this project or programme?
$
6.4
Assuming this application is successful, how much more does your organisation still need to raise to
complete this project?
$
2017 Application Form | Page 7
6.5
Summary of project funding:
Amount requested in this application (section 6.1)
$
Total already raised (section 6.3)
$
Total still to raise (section 6.4)
$
Total cost of project
$
6.6
If your organisation already has funds available, why are they not being used for this project?
6.7
Has your organisation applied, or do you intend applying, to another funding organisation for the same
purpose? If yes, please specify.
Section 7: Your Organisation’s Finances
7.1
To help us assess this application, please attach a copy of your latest financial accounts or latest
audited financial accounts.
Are there likely to be any significant changes to your financial situation in the next 12 months?
If yes, please explain.
7.2
Please include a bank statement deposit slip or bank statement that matches your
organisation name.
2017 Application Form | Page 8
Section 8: More Information
Finally, is there anything else you think we should know about your organisation or the project?
(maximum 500 words)
2017 Application Form | Page 9
Section 9: Applicant Declaration
• This application has the formal approval of our Board/Committee/Authority, and;
• to the best of my knowledge the information provided herein and on any supplementary sheets are true and
correct, and;
• that further information provided by us during the course of assessment of this application will be true and
correct, and;
• we acknowledge that any decision made by the SKYCITY Auckland Community Trust is final. We accept that
no reasons for such decision will be given, nor will any correspondence be entered into, and;
• that if this application is successful, the funds awarded will be applied to the purpose as stated in Section 2 and
not applied to any other purpose without the express permission of the SKYCITY Auckland Community Trust
having first obtained, and;
• that any funds paid which are surplus to the stated purpose will be repaid to the SKYCITY Auckland Community
Trust, and;
• that documentary evidence of the expenditure will be provided to the SKYCITY Auckland Community Trust
within 30 days of the expenditure of the funds awarded.
• If this grant is successful, we will participate in the roundtable evaluation as part of the SKYCITY Auckland
Community Trust’s accountability process.
For email respondents: By activating the ‘Signature Check Box’ you are confirming your
acceptance of all clauses in this declaration.
For and on behalf of our organisation:
For printed and mailed forms
For emailed forms
Signature:
Signature Check Box:
Name:
Name:
Position:
Position:
Date:
Date:
Checklist:
Completed all the questions?
Checked all the figures add up?
Enclosed copies of quotes where
relevant to funding request?
Enclosed copies of your latest financial
accounts?
Enclosed a copy of bank deposit slip or
bank statement with matching organization
name?
2017 Application Form | Page 10
Deadline and contact details:
Friday 31 March 2017, 5pm
Application deadline
• To arrive or be postmarked no later than the deadline
• No late applications will be accepted
What needs to be
included
• Do not include documents other than what has been requested.
We will contact you should we require any futher information.
Post to:
SKYCITY Auckland Community Trust
PO Box 90643
Auckland 1142
Courier or by hand:
SKYCITY Auckland Community Trust
Federal House
86 Federal Street
Auckland 1010
Phone:
Natalie Vincent
Community Trust Manager
09 363 6117
Email:
[email protected]
Our preferred method of application is by email.
2017 Application Form | Page 11