Kathy Barnett Memorial Leadership Grant Application 2017

Please refer to the Kathy Barnett Leadership Grant Application Guide 2017 document for information on eligibility and terms of the grants. There are 6 sections to this grant application. Please also take note of the supporting documents which must accompany your application

Applications are due on Tuesday March 21, 2017 at 5:00 pm. Please submityour application and accompanying documents via email to . Your reference letter can be sent via email to directly by your reference or mailed to the following address:

Community Foundation of Whistler

Attn: Kathy Barnett Leadership Grants Program

PO Box 1184, Whistler, BC V0N 1B0

Please direct any questions to Carol Coffey at or call 604-935-8080

Part 1: Contact Details

Applicant Name:

Address:

Telephone:

E-Mail:

Name of partner Charity:

Address:

Contact person at charity:

Telephone:

Email:

Charitable Registration No:

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Kathy BarnettLeadership Grant Application 2017

Community Foundation of Whistler

Part 2: Program Information

  1. How long have you lived in the Sea to Sky Corridor?
  1. Please provide the name of program you would like to participate in and a brief description of this program (include any applicable hyperlinks to program descriptions):
  1. State the mission and vision of your partner organization:
  1. Describe your role / relationship with your partner organization:
  1. What is the change you would like to see in the community as a result of your having undergone this professional development experience? Include a description of the community or population with which you work and define the outcomes you wish to attain in the community.
  1. Describe how the outcomes of your program are linked to your partner organization’s mission:
  1. How will you and your charitable organization evaluate your experience in this program, beyond any grades or evaluation provided by the program instructors? What indicators will you use to evaluate your success?
  1. When are the funds required for the project?
  1. How will this grant be acknowledged and how will you collect and share your story about the impact of your work with the Community Foundation of Whistler and the wider community? Please be specific.

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Kathy BarnettLeadership Grant Application 2017

Community Foundation of Whistler

Part 3: Budget

Program Expenses / Amount
Program fees
Travel
Accommodation
Text Books and other program costs
Per diem
Other (specify)
Total expenses
Revenues / Confirmed? / Cash / In-kind / Total Amount
CFOW - requested
Funding on hand
Partner organization contributions
Other (specify)
Total revenues:

Part 4 – Reference Letter

You must include one letter of reference as part of your application.

Referee Name:

Address:

Telephone:

E-Mail:

Occupation:

Part 5 – Supporting Documentation

Please include the following documents with your application:

  • Your resume
  • 1 (one) copy of the program information brochure or a hyperlink to a website containing the information about the program.

Part 6: Declarations

To be completed by applicant:

I hereby declare that the information contained in this application is to the best of my knowledge correct and complete. I will submit proof of registration in the program associated with this award. I understand that I have one year from the date of the grant being awarded to utilize the grant. I realize that if proof of registration is not submitted, the Community Foundation of Whistler reserves the right to cancel my award. I will notify the Community Foundation of Whistler if I withdraw from my program.

Signature Date

To be completed by partner organization:

We certify that this application for funds has official approval from the organization’s Board of Directors.

Print Name Senior Staff Signature

Print Name Chairperson/Board Representative

Date

Thank you for taking the time to submit your application to the Community Foundation of Whistler.

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Kathy Barnett Leadership Grant Application 2017

Community Foundation of Whistler