Application for Financial Assistance Discretionary Grant

Organization/Group Information

Organization/Group

Address

Town

Postal Code

Phone Number

Email Address

Incorporated or Registered No.

Directors and Executives of the Organization/Group

List Name, Address, Board Position, Email, and Phone Number

Number of Paid Members in the Organization/Group

Number of Volunteer Members in the Organization/Group

Discretionary Grant Requested

Total Request $

Program Year

NOTE: The Town is retroactively funding projects in 2023 for events/programs/activities/initiatives which meet the intent of the Town's Discretionary Grant Policy.

If you're applying for multiple program years, please fill out two separate forms.

Please attach additional pages where ever required

What is this request for? Please outline the objectives and plans for the event/program/activity/initiative you wish to receive Town funding for. If you have previously received financial assistance/discretionary grant funds, please outline how this event/program/initiative is different.

NOTE: Per the Town's Discretionary Grant Policy, only new events/programs/activities/initiatives will be considered for funding. For existing events, only new events/programs/activities/initiatives will be considered.

Is there an entrance fee or ticket cost associated with this event/program/activity/initiative?

Yes

NOTE: Per the Town's Discretionary Grant Policy, events/programs/activities/initiatives that charge a ticket price will not be considered eligible for funding.

How will the event/program/activity/initiative for which you are requesting funding address the objective(s) you previously identified? Be as specific as possible.

NOTE: Detailed budget or forecast as well as financial statements for the current year and one or more previous years for first time applications, are to be attached.

How does the Organization/Group plan to fund the remaining amount for the event/program/activity/initiative? Please indicate sources or expended sources, dollar amounts and the corresponding percentage of total operating revenues.

Has the Organization/Group requested funding assistance in the last twelve months from any other municipal, provincial or federal department or agency? Please expand on the type of funding the Organization/Group has requested.

Outline the Organization’s/ Group's major goals, objectives and plans for both the upcoming year, and for the future in general.

Describe the community needs addressed by the Organization/Group.

NOTE: Any applicant is welcome to include a covering letter with this application form, however the covering letter and full application package (excluding financial statements) should not exceed five (5) pages.
ACKNOWLEDGMENT OF RESPONSIBILITY FOR DISCRETIONARY GRANTS
Having received approval of the request for financial assistance from the Council of The Corporation of the Town of Niagara-on-the-Lake, the Organization/Group agrees to the following conditions:
1. The Organization/Group confirms that the representations contained in the application for financial assistance are true and correct in every respect and that in the event that the funds are not used for the project or programs as described in the application, or if there are misrepresentations in the application, the full amount of the financial assistance will be payable forthwith to the Town.
2. If there is any change in the funding of the project from that contemplated in the application, the Organization/Group will notify the Town of such changes forthwith.
3. The Organization/Group will make or continue to make attempts to secure funding from other sources as so indicated in the application.
4. The Organization/Group will keep proper books of accounts, of all receipts and expenditures relating to the project or program.
5. The Organization/Group will make available for inspection by the Town or its auditors, all records and books of accounts of the Organization/Group upon request from the Town.
6. That if the project or program proposed in the Organization's /Group's application is not commenced, or is not completed and there remain Town funds on hand, or is completed without requiring
the full use of the Town funds, such funds will be returned to the Town.
7. That the project or programs not be represented as a Town project, and that the Organization/Group does not have the authority to hold itself out as an agency of the Town is any way; the only
relationship being the Council of the Corporation of the Town of Niagara-on-the-Lake has approved and granted financial assistance to the Organization/Group.
8. That if the Organization/Group is involved in activities or assuming positions that are not consistent with the vision and values of the Corporation of the Town of Niagara-on-the-Lake, Council reserves the right to suspend and potentially terminate grants at their sole discretion at any time.

Additional Comments

Signature of Signing Officer on behalf of the Organization/Group

Sign above

Print Name and Official Position

Date

Check this box if the individual above is a Signing Officer on behalf of the Organization/Group

Additional Documents

Maximum 10 files.
32 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

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