Wetzin’kwa Community Grant Application Form

Proponent Information
Name of organization:
Type of organization:
Registered Non-profit / Registered Charity
Other (specify)
Mission/vision of your organization:
Summary of Organization’s revenue and expenditures of previous year
Contact Information
Address: / Phone:
Main contact: / Email:
Project Overview
Project Name:
Location of project:
Brief Summary of Project: - one paragraph
Project Category
Arts & Culture / Recreation / Environment, / Social Services
Conservation & Natural Resource Management / Community Economic Development
Project Rationale: - Why is this project important?
Project Objectives: - What will this project accomplish?
Community Benefit: - Which communities, groups or individuals will the project benefit?
What is the project start date and timeline?
What are your communications and outreach plans?
Describe the potential environmental impacts and mitigation plans:
Project Partners: - List your project partners, opportunity to leverage other funding with the Wetzin'kwa requested funds, or use of volunteers:
Project evaluation and reporting: - Please provide a list of project activities and indicators of success, as well as the type of reporting that will be completed for the proposed project.
Letters of Support: - Please attach a maximum of 3 letters of support (PDF format)
Budget - Human Resources:
Item / Costs / Funding sources
Wetzin’kwa / Other (specify) / In-Kind
e.g. Bike Maintenance volunteer / 40 hours x $10/hr = $400 / 0 / 0 / $400
Total Human Resources
Budget - Materials, Supplies and Equipment
Item / Costs / Funding sources
(#s, unit costs and total) / Wetzin’kwa / Other (specify) / In-Kind
E.g. Bike repair tools / 10 crank wrenches @ $16 = $160 / $120 / $40 (where from) / 0
Total Materials
Budget - Other Expenditures
Item / Costs / Funding sources
Wetzin’kwa / Other (specify) / In-Kind
E.g. Ad in newspaper / $500 / $300 / $200 (BVCU) / $0
Total Other
Budget Total Costs and Expenditures
Total costs for project / Total requested from Wetzin’kwa / Total other cash donations / Total in-kind support

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