A. Applicant Information: A.1. Group/Organization Applying * A.2. Contact Person(s) * A.3. Address * A.4. Phone Number * A.5. Email address * A.6. When was your group/organization established? * A.7. Is your group/organization Not-For-Profit or Non- Governmental? * Yes No A.8. Is your group based in the Rural Municipality of West River? * Yes No B. Grant Type B.1. What type of Grant is being requested? * Monetary Grant In-Kind Grant B.2. Requested Donation Amount (If Monetary Grant Requested) - CAN$ B.3. Identify the requested goods, commodities, or services (If In-Kind Grant Requested) C. Reasoning for Request: C.1. How will the donation be used? (up to 100 Words) * C.2. Has your group/organization received any other funding for the purpose stated above? * Yes No If the answer to question (C.2) is "Yes," please provide these information: Amount From Date C.3. Has your group/organization fundraised prior to this request, for the purpose stated above? * Yes No If the answer to question (C.3) is "Yes," please provide these information: Amount Date C.4. How does your group/organization contribute to the community and its residents? (up to 100 Words) * C.5. Does your group/organization agree to to acknowledge the Municipality's contribution in all publicity/promotion relating to the event or activity to which the grant applies? * Yes No Applicant Name * Date * I Hereby Affirm and Declare to the Municipality That: (a) By submitting this application, I am confirming that all information stated above is true and accurate. (b) By submitting this application to the Municipality, I consent to the collection, use, and disclosure of the personal information in this application by the Municipality for the purposes of processing this application, making a decision, and publishing public notice of the decision in relation to this application. I understand that the personal information contained in this application is being collected, used, and disclosed by the Municipality in accordance with Bylaw #2021-05 – Access to Information and Protection of Personal Information – and the Municipal Government Act, including the Access to Information and Protection of Personal Information Regulations. I also understand that, if I have any questions about the collection, use, disclosure, or correction of the personal information, I can contact the Chief Administrative Officer of the Municipality at 902-675-7000 or admin@westriverpe.ca. Leave Blank
