*Full name of applicant or group:
*Email:
*Contact person ( for a group ):
*Phone number:
Your Contact
*Are you applying as an individual or a group?
Individual
Address if living in Otorohanga:
Or tell us how you are associated with Otorohanga District:
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Group
( please tick as many as are applicable )
Registration number:
please specify:
Individual or Group
What and How
*What are you seeking a grant for? (Please describe your project in detail including when it will happen.)
*How will your project benefit the Otorohanga District?
Budget and Funding
Project budget
Project funding
Amount requested from Otorohanga Charitable Trust:
Item
Total $
Cost
Source of funding
(e.g. fundraising, grant applications, sponsorship, donations)
Amount
Confirmed
(yes or no)
Total $
Confirmed
(yes or no)
Do you give permission for us to share information about what you do or any grant we may approve to you on our facebook page or other social media?
Your Permission
Supporting information
(e.g. letters of support, quote)
Please combine all the supporting documents into one file.
*For groups: your most recent set of financial statements (required)
​
Please combine all the statements into one file.
*Proof of bank account details for account any grant will be paid into (required)
Financial Statements
Proof of bank account
Please Attach
*Signed:
*Name:
*Position:
You will be contacted by the Trust after your application has been considered.
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