ࡱ> IKFGH` 2bjbjss bH)\HHH\8x\Xn($h 6H^6KJJJ8HJJJ0H\L jW/"D a0B@D\H\ͯJg|66^\\\QWN\\\W\\\ Office Use Only Project#CM:A Code:Round: 1D Code:A / D:FC:AR:AA: SHAPE \* MERGEFORMAT  Creative Communities New Zealand Scheme Closing date: 4pm Friday 2nd October 2009 Applications are invited for funding from the Creative Communities New Zealand Scheme, Kapiti Coast District. Projects must meet funding criteria (see last page). Please read through this form carefully and answer all questions. Applications must be complete, and include the required additional documentation. If you have any queries before the closing date, please contact the Arts & Museums Development Officer, Kapiti Coast District Council, on (04) 296 4688. 1. Brief Project Identification Project Name Project Short Description (more detail in later section) Purpose of Requested Funding Brief Description (more detail in later section) Amount Requested $  2. Organisation / Individual Applicant Contact Details Contact Person (readily available) Name:Daytime Telephone Number Evening Telephone Number (optional) Mobile Phone Number Email Address  Do you or a representative of your organisation wish to speak to the Allocation Subcommittee in support of your application? (circle one) Yes / No 3. Formal details for Organisation / Individual Applicant Organisation / Name  Postal Address Is your organisation a legally constituted trust or incorporated society? (specify)GST Registration Number (if GST Registered) Bank Name and Branch Bank Account Name  Bank Account Number4. Organisation Details (Enter N/A if individual applicant) What are your organisations primary objectives? (NB Do not describe your project here)  How many people belong to your organisation? 5. Applicant Affiliation What is the MAIN cultural or ethnic affiliation of your organisation, or yours as an individual applicant? Tick ONE box only  ( All ( Maori ( NZ European / Pakeha ( Pacific Island ( Other please specify: _______________________________________ 6. Provide two references for you and your project Reference 1 Name Daytime Telephone Number Email address Reference 2 Name Daytime Telephone Number Email address  PROJECT PROPOSAL 7. Project description Please tell us about your project in full: __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _______________________________________________________________________ 8. Project Details When will the project take place? Where will the project take place? How many organisers will be involved? Select the arts grouping that best fits your project Tick ONE box only Language arts and literature [e.g. poetry, story telling, fiction, whai korero] Performing arts [e.g. dance, music, theatre] Visual arts [e.g. painting, craft, toi whakairo] Multi-disciplinary [projects which cross over two or more of the above categories] Which of the Creative Communities Scheme Criteria bests fits your project? Tick ONE Only Increases participation in the arts (Will usually involve opportunities for active participation for the community the project is aimed at) Increases community interest in the arts (Will often involve presentation of new works and experiences to the community the project is aimed at) Strengthens and enhances the local arts sector (May involve training, engagement of consultants, purchase of equipment, networking and seminars) How will you advertise or promote the project?  What will be the benefits of your project taking place?  9. Audience / Participation What is the expected size of your target audience / number of participants? What age group are you aiming at with your project? Tick ONE box only ( Under 25 ( Over 25 ( All ages Which cultural or ethnic group is your project intended to involve? Tick ONE box only ( All ( Maori ( NZ European / Pakeha ( Pacific Island ( Other please specify: ___________________________________ Which district do you expect your audience to come from? Please give your best estimate  10. Budget (money and resources) Note: Creative Communities Scheme grants are usually between $100 and $2,000Outline the costs of your project. You may include a percentage of overhead costs, including salaries [except volunteer labour], which apply to the project. Where appropriate, please include written quotes. Please outline how you intend to fund the project excluding Creative Communities New Zealand scheme application. Please note you must contribute a minimum of 50% of the total project costs & provide proof of the availability of those funds. Project cost Income This includes all costs that your project will incurThis covers money you have in the bank, ticket or other sales, other grants, intended fundraising, etc $$$$$$$$$$$$$$$$$$$$$$$$ Total cost of this project is A $Your contribution is B$ Total Cost of the Project  A$LESS Total Funds Available - B$AMOUNT REQUESTED  =$ If the funding request has any items over $1000, you must supply three current written quotes. Email and web quotes are not acceptable. The only exception is if there is only suitable option, eg a preferred tutor, venue, etc. This must be specified. Type of assistance requested Tick ONE box only( Grant ( Guarantee Against Loss ( Loan For this project, tell us about any other grants, loans, guarantees against loss, that you have applied for from other sources. This is important. DateSource TypeAmount Funding Advice Date     Financial Background If you are an existing group or organisation, you must provide a copy of your last set of audited annual accounts plus a copy of your most recent bank statement. Also, if you have previously received funding through the Creative Communities New Zealand scheme, by way of grants, loans or guarantees against loss, provide details below: DateProject TypeAmount $    HAVE YOU : [Tick (] Completed every section Only used one side of each page Saved a copy for yourself Included your last set of annual accounts plus copy of latest bank statement Checked Section 10 This section needs to be absolutely accurate and complete. Signed this form. DONT STAPLE YOUR INFORMATION, PLEASE SUPPLY IT IN AN ENVELOPE. Do not include any other promotional material just the form and your financial documents. If this application form is incomplete, it will be returned. This could mean that you miss the closing date. Late or incomplete applications cannot be accepted. I declare that the information supplied here is correct. If the application is successful, I agree to: Return the project report form [which will be sent to me in due course by the local authority]. Participate in any funding audit of my organisation or project conducted by the local authority. I consent to the Creative Communities Scheme Kapiti Coast District SubAllocation Committee and administration personnel collecting the personal contact details provided above, retaining and using these details and disclosing them to Creative New Zealand for the purpose of review of the Creative Communities New Zealand scheme. I acknowledge my right to have access to this information. This consent is given in accordance with the Privacy Act 1993. Name: _______________________________ Signature: _______________________________ Position in Organisation: _______________________________ Date: _______________________________  WHAT ARE THE FUNDING CRITERIA? Projects seeking assistance must meet at least one of the three funding criteria. These are to: increase participation in the arts at a local level increase the range and diversity of arts at a local level enhance and strengthen the local arts sector ELIGIBLE PROJECTS INCLUDE: events or festivals personnel costs for one-off, short-term projects costs associated with artist-in-residence schemes materials for an event or activity seminars or workshops dance that has an arts or cultural focus (eg ballet, tap, taiaha, highland dancing, rock 'n' roll) school-based projects that are outside the school's normal activities and provide benefits for the wider community.  ELIGIBLE PROJECTS MUST: have an arts or cultural focus take place within the district to which the application is made and/or benefit that district meet at least one of the three funding criteria benefit local communities not have started before an application for funding is assessed not have been funded by Creative New Zealand for the same purpose. ACTIVITIES THAT CAN'T BE FUNDED REPEAT APPLICATIONS facility development (eg cost of buildings, plumbing, floor coverings, furnishings, fixtures) activities that are the responsibility of education institutions administration costs not related to a specific project projects that have already been completed servicing of debts catering salaries for ongoing administration and services  If you are have any queries on this please contact the Arts & Museums Development Officer, Kapiti Coast District Council, on (04) 296 4688     CCS Kapiti Coast Page  PAGE 1 of  NUMPAGES 10 Application Form 2009-10 prize money fundraising  !23BCHIQRSjklmnops¹¢Œ}kYHk h3ahw@]CJOJQJ^JaJ#h3ah>5CJOJQJ^JaJ#h3ahw@]5CJOJQJ^JaJhiA5CJOJQJ^JaJh3ah>^Jjbh3ahw@]U^J,jh3ahw@]U^JmHnHsH tH uh3ahw@]^Jjh3ahw@]U^J h3ahw@]CJ^JaJmH sH h3ahw@]^JmH sH #h3ahw@]6CJ^JaJmH sH  Hkd$$Ifl0H    t 6U0644 l` ap$U&#$/Ifgdw@]11 2 !)2ZHH$U&#$/Ifgdw@]kd$$Ifl0H    t 6U0644 l` ap23;BZHH$U&#$/Ifgdw@]kd$$Ifl0H    t 6U0644 l` apBCGHZHH$U&#$/Ifgdw@]kdF$$Ifl0H    t 6U0644 l` apHIMQZHH$U&#$/Ifgdw@]kd$$Ifl0H    t 6U0644 l` apQRopqrsZXXPPPPPX$a$gdw@]kd$$Ifl0H    t 6U0644 l` ap 6 8 F [ \ k l m n o p     yoeTeeG>h$Xhw@]^Jh-hCJ^JaJ h$XhiACJ^JaJmH sH h-CJ^JaJh$XCJ^JaJh$X5CJ^JaJhRxhRxCJ^JaJhRx5CJ^JaJh-hw@]5CJ^JaJh-hw@]CJ^JaJh-CJ^JaJh3ahw@]CJ^JaJ hiA^J h-^J#h3ahw@]5CJOJQJ^JaJ&h3ahw@]5CJH*OJQJ^JaJ7 8 o p   $If $Ifgdk$a$gdhlp^pgdp^pgd dgd-  # 4 k   1 7 B C a ˾~wndXNGn h3a5^Jh3ah3a5^Jhhlh3a5>*^Jh3ahhl5^Jhhlhhl^J h5^Jhhlh5>*^Jh3ah^Jh3ah5^Jh3ahcC^J hOO5^Jh3ahk5^J h5^Jh-h^JmH sH h$X^JmH sH h$Xh^J hiA^Jh$Xhw@]^JhiAh-5^Jh$Xh-^J       qhhbbbbb$If $Ifgdkkd$$IflF  - k t06    44 la  1 C b c d e f g h qhhhbbbbbb$If $Ifgdkkd$$IflF  - k t06    44 la a b c g i z { | } ~  ' ( ż춫vivi^^Pi^Ph3ah$X5^JmH sH h$X5^JmH sH h3ahk^JmH sH h3ahk5^JmH sH hk5^JmH sH h3ahg=5^JmH sH h3ah[5^JmH sH h5^JmH sH  hiA^Jh3ahk^JhOOhk5^JhOOhOO5^Jh3ah5^Jh3ah3a^Jh3ah^Jh3ahhl5^Jh i z { } ~  qhbbbb$If $Ifgdkkd.$$IflF  - k t06    44 la qooiiii$Ifkd$$IflF  - k t06    44 la  ~~~~~$Ifzkdj$$Ifl0 a  t0644 la    ' ( ) {{{uuu$If $Ifgd$Xzkd$$Ifl0 a  t0644 la) * > ? @ ~~~$Ifzkd($$Ifl0 a  t0644 la( * = > ? 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