Please print clearly or type in boxes

PART A: APPLICANT DETAILS
GRANT RECIPIENT
FULL NAME
ADDRESS
DATE OF BIRTH / ID NUMBER
PHONE / LOCAL TEAM
EMAIL / REGIONAL HUB
INDICATE WHICH GROUP THE RECIPIENT BELONGS TO
☐PIPPIN ☐BROWNIE ☐GUIDE ☐RANGER ☐LEADER
APPLICANT if different from above (ie you are submitting on behalf of the grant recipient)
FULL NAME
ADDRESS
PHONE / LOCAL TEAM
EMAIL / REGIONAL HUB
RELATIONSHIP TO RECIPIENT
IF APPLICANT IS NOT THE PARENT/GUARDIAN:
PARENT/GUARDIAN APPROVAL / I GIVE APPROVAL FOR ______TO MAKE THIS APPLICATION ON OUR BEHALF
SIGNED
☐ I HAVE SPOKEN TO THE GRANT RECIPIENT AND THEY ARE AWARE OF THIS APPLICATION
PAYMENT SHOULD BE MADE TO
PLEASE INDICATE WHO BELOW / NAME / BANK ACCOUNT NUMBER
☐ / APPROPRIATE GIRLGUIDING NZ ACCOUNT
☐ / GRANT RECIPIENT / AS ABOVE
☐ / PARENT/CAREGIVER
☐ / OTHER - please state
OFFICE USE ONLY / ☐RECEIVED / ☐ACKNOWLEDGED
PART B: GRANT DETAILS
Complete ALL relevant section/s.
EVENT
Note: Side trips before and after an event are not funded.
EVENT NAME
LOCATION / DATE / DURATION
COST / $ REQUESTED
EVENT FEE
TRAVEL
ACCOMMODATION
TOTAL A / $

Indicate subsidies and fundraising below as relevant

SUBSIDIES TO BE RECEIVED FROM / AMOUNT
OTHER FUNDING, EG RUTH HERRICK/MONA BURGIN SCHOLARSHIP, OTHER GRANTS
TOTAL B / $
FUNDRAISING / AMOUNT
FUNDS RAISED TO DATE
FUNDRAISING ANTICIPATED
TOTAL C / $
SUBTOTAL B + C / $

Subtract Subtotal B + C from Total A above

TOTAL REQUESTED / $
PLEASE OUTLINE DETAILS OF FUNDRAISING TO DATE AND/OR PROPOSED, AND ANY OTHER FINANCIAL INFORMATION THAT MAY BE RELEVANT
PART C: REASONS FOR GRANT
Please include information related to the grant recipient
PLEASE OUTLINE REASONS FOR WISHING TO ATTEND THIS EVENT AND RECEIVE FUNDING, WHAT IS BEING GAINED FROM THE GIRLGUIDING EXPERIENCE AND HOW FUNDING WILL ASSIST
PART D: ADDITIONAL INFORMATION
Please outline any international, national, regional or local Guiding events you/the grant recipient has attended.
Attach separate A4 sheet if necessary.
NAME OF EVENT / DATES / TYPE OF EVENT / TOWN/COUNTRY
STATE ROLES THE GRANT RECIPIENT HAS IN GUIDING eg Girl member, Brownie Leader, Pippin helper
STATE OTHER INTERESTS OR HOBBIESTHE GRANT RECIPIENT HAS
PART E: DECLARATIONS
APPLICANT DECLARATION
I have read the ‘Notes for Applicants’ and wish to apply for a GirlGuiding NZ Foundation grant. The information given is accurate and true.
SIGNATURE OF APPLICANT / DATE
Please include/attach any information or endorsements which may be relevant to this application.

IT IS A CONDITION OF EVERY GRANT THAT THE RECIPIENT PROVIDES A REPORT TO THE FOUNDATION AFTER THE EVENT OUTLINING HOW THEY HAVE BENEFITTED FROM THE FUNDING PROVIDED.

APPLICANT CHECKLIST
Use this checklist to ensure you have completed all sections of the form.
COMPLETED
☐ / PART A - GRANT RECIPIENT DETAILS
☐ / PART A - APPLICATION DETAILS, IF DIFFERENT TO GRANT RECIPIENT, INCLUDING PARENT/GUARDIAN APPROVAL
☐ / PARET A - PAYMENT DETAILS
☐ / PART B - GRANT DETAILS - EVENT
☐ / PART C - REASONS FOR GRANT
☐ / PART D - ADDITIONAL INFORMATION
☐ / PART E - APPLICATION SIGNED
REGIONAL HUB CO-ORDINATOR ENDORSEMENT
I have spoken with the applicant and endorse this application for a GirlGuiding NZ Foundation grant.
NAME OF REGIONAL HUB CO-ORDINATOR
REGIONAL HUB
SIGNATURE OF REGIONAL HUB CO-ORDINATOR / DATE
Please include/attach any information or endorsements which may be relevant to this application and forward to the Governance Administrator.

PLEASE ENSURE THIS APPLICATION IS RECEIVED AT NATIONAL OFFICE BY THE DEADLINE (31 MARCH OR 31 JULY)

Send to:

GirlGuiding NZ Foundation

C/- Governance Administrator

PO Box 13 143

Christchurch 8141

Or email to

or email to by 31 March or 31 July

Publicity Permission - please complete the Publicity Permission Slip on the next page.

PUBLICITY PERMISSION SLIP
To help us promote the Foundation we appreciate feedback from grant recipients eg thank you letters, and photos which may be used in newsletters and/or local papers.
Please consider the statement below, agree or not agree, and sign. Should you choose to decline we will respect your privacy. Your decision will not impact the grant process.
PERMISSION IS GIVEN FOR THE GIRLGUIDING NZ FOUNDATION TO PUBLICISE
DETAILS OF ANY GRANT MADE TO THE APPLICANT / ☐ AGREE ☐ DO NOT AGREE
SIGNED / RECIPIENT OR PARENT/GUARDIAN
NAME OF GRANT RECIPIENT

GGNO153a - Updated 2018