Municipal Grant Online Application

Please ensure you have read the Municipal Grants Policy before completing the form.

YOU MUST COMPLETE THE APPLICATION FORM, INCOME STATEMENTS, BALANCE SHEETS AND ATTESTATION IN FULL.

PART A: Municipal Grant Request – SUMMARY

Name of Organization/Agency *

Contact Person/Title *

Please provide full name and title

Phone Number *

Email Address *

Mailing Address

Address *

City *

Province *

Postal Code *

Type of Organization

Non-Profit Organization? *

Yes

Registered Charity? *

Yes

If yes, indicate the Charitable Registration Number: *

Event Information

Name of Event/Program *

Amount Requested ($) *

Prior Year Request ($) *

Prior Year Grant ($) *

PART B: Municipal Grant Request – INFORMATION

1) Please briefly describe the organization’s programs and services. *

2) Please provide a statement of the organization’s goals and objectives: *

3) If Council approves the organization’s Municipal Grant Request, what will the funding be used for? Please provide a detailed cost breakdown analysis. *

4) Please provide a description of how the organization intends to measure the success of the program or service: *

5) Will you be working jointly with other partners/stakeholders? *

6) Does the municipality provide any other support, assistance or in-kind services to your organization? *

7) How will the organization decrease the reliance on municipal funding? *

8) Please identify how the Municipality’s financial support will be acknowledged. If possible, provide examples. *

9) Additional Information (Optional):

PART C: Municipal Grant Request – ATTESTATION

Instructions

PLEASE DOWNLOAD AND PRINT THE FOLLOWING LINK AND PROVIDE AUTHORIZING SIGNATURE. ONCE COMPLETED, THIS FORM CAN BE UPLOADED INTO THIS FORM.

Municipal Grants Application - Signatures

PART D: Municipal Grant Request – FINANCIALS

Submission of the Organizations Statement of Operations is required, along with a balance sheet or statement of financial position.
If the organization is new, or the initiative is new, please submit along with the application a financial plan or budget for the initiative projecting the financial position to year end or the end of the initiative whichever comes latest.
- If the initiative is a multi-year event, provide amulti-year budget/projection.

All financial statements shall include as a minimum;

All Revenues
All Expenses
Any Assets
Any Liabilities

*The statements must balance in all cases.

Upload Signatures and Financial Documents *

Drag and drop files here or Browse

Upload ALL Required Documents

Phone

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Contact Us

Staff Directory

Phone: 613-259-2398
Fax: 613-259-2291

Office Hours

Monday to Friday
9:00 am - 4:00 pm

Office Location

75 George Street, PO Box 340
Lanark, ON K0G 1K0