Community Grant Program Sample Application

[Pages:9]Community Grant Program Sample Application

This sample application is based on a successful Community Grant Program application. It is designed to assist you in the application process by providing an example of several of the features we are looking for in an application. Please also refer to our Application Guide for further help. If you have questions, need additional assistance, or have suggestions for improving this example, please contact Rhonda Newton, CIF Grants Administrator at 306.780.9308 or by email at rnewton@



COMMUNITY GRANT PROGRAM APPLICATION FORM

April 1 -- Annual

Application Deadline (select one)

3

October 1 ? Annual

February 1 -- Summer

3 Type of Grant (select one)

Annual Local ($25,000 maximum)

Summer Local ($5,000 maximum)

Annual Provincial ($50,000 maximum)

Summer Provincial ($10,000 maximum)

Region Where Project Will Be Delivered (select one)

To determine the correct region refer to the map at grants/apply--here.

North

3

Central

Provincial (select one below)

The project will occur in more than one region.

South

Project participants will come from more than one

region.

Grant Request $ 1 4,500

APPLICANT INFORMATION (Please provide your responses in the shaded areas).

abytpTuoophdulmiigscraeaenttqt,ciuuhloamnettsh.ebtreeiriannnmtethoheuedens t

Organization Anytown Centre for Inclusion and Learning

Address

Box 123

Community Anytown, Saskatchewan Postal Code S 0K 1Z0

Primary Contact Person Ms. Jane Smith Position / Job Title Executive Director Phone (306) 123-4567 Email janesmith@ Fax (306) 123-7654

Alternate Contact Person John Doe Position / Job Title Program Coordinator Phone (306) 123-1234 Email johndoe@ Fax (306) 123-7654

Community Initiatives Fund

1

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Jan 2017

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Project Title Project Title PPrroojjeecctt

TSittalret Date Project Start Date

Inclusive Social Club

2016/12/01

Project End Date Project End Date

2017/11/30

lPirkoejetchtisstohnaet,asrteilolnngeoeidng, to indicate a start and end date. The start date must be at least two months after the application deadline you are applying to.

PLorocjaetciot n S(tsa)r ot fD Partoeject Activities (communities, fLaoccilaittiieosn) (s) of Project Activities (communities, facilities)

VParroiojuesclto c Eantidon Ds waittehin Anytown such as the recreation

centre, church hall, shopping mall, and sporting venues.

LEoxceac8uotinve(s S) uomf Pmroarjeyc ot f A Pcr8ovjei8cte s(m (acoximmmumun5i060ews,o rds) Provide a brief summary of the project that fmEaxcaeilyci6 u betesiv) ues e Sdu m asm aa prryo ojefc Ptr doejescctri (pmtiaoxnim fuomr o50u0r w groardnst)

a Pdrojuvdidicea tai o bnri eanf dsu cmommmaruyn oifc a thtieo n p r poujerpcot s tehsa.t

may be used as a project description for our grant adjudication and communication purposes. The Anytown Centre for Inclusion and Learning works to reduce barriers facing young

Eaxdeucluts8vwei t Shucmommaprleyx opfh Pyrosijecactl (dmisaaxibmiulimti 5e0s0. Wwoerdcsr)e Partoevoipdpeo art burnieift i seusmthmroauryg ohfo tuhre I pnrcoljuescitv tehat mSoacyi able C ulsuebd, atsh ea T peraocjehcitn dgeascnrdipLIoeanr fnoirn ogurC genratnrte , atdhjeudSicuamIomne ar nLdi t ceoramcmy uPnriocgarIaomn ,paunrpdoPseast.h

to Future Endeavours.

The Inclusive Social Club is led by five vibrant young adults with and without disabilities that plan and carry out monthly social, recreational, and physically active events for young adults with complex physical disabilities, volunteers, and the entire community. Our staff work with, and mentor, the planning team to increase their leadership skills and to develop program planning skills (assessing, planning, promoting, implementing, and evaluating). The team actively recruits and orientates Cvomolmuunntiteye r Inui6na6ivveesr s Fiutnyd s t u d e n t s t o a s s i s t w i t h e v 84e n t i m p l e m e n t a t i o n . August 2014

Two events are offered, the largest event is an adapted hip-hop initiative held monthly. The second event changes monthly, is typically scheduled on weekends or in the evenings, and can include a variety of activities such as barbeques, sports events, bowling, and holiday celebrations.

Community Initiatives Fund

3

Community Initiatives Fund

3

Jan 2017 Jan 2017

Project Objectives

Briefly describe the community and the issue your project is designed to address. If the project has been offered before, briefly describe the results and any changes that have been made to the project to improve outcomes for participants.

Project Objectives

Briefly describe the community and the issue your project is designed to aPdrodjreecsts .O Ibf jtehcet i pvreosj e

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and any changes that have been made to the project to improve outcomes for participants.

The Inclusive Social Club aims to address three issues. First is to reduce the multitude of barriers that young adults with disabilities encounter to participate in community social activities. Through program education and participation, barriers such as lack of knowledge and social ineffectiveness will be reduced. By providing events that are PattSetfhdrrhinaovuedegctejrlec o a yehmoncgsamtsadvee .Ocmem i Iicbfn s beb u jtseetehlnshreceeiatenitb i tpdev l l ymaraeeeomrcsaaisjkn de n h , Bceoiwdartp f it eehofmoofrap p p ltesyelhppeaa

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ci ue rcetcteecitisvtict,eivhitdcpeiashaeotsanuttlathtllsceek,noPmsngraoeoetsbsje,otcfhuatoentr d developing leadership skills.

Finally, the social club is an opportunity for all young adults in the community to develop skills, participate in community activities and work alongside their peers.

Describe who will participate in and/or benefit from the project. If the project has been offered before, briefly describe the results and any changes that have been made to the project to improve outcomes for participants.

DTehsecIrnibcelu wsihvoe wSiolcl i paalrCtilcuipbahtaes inb e aenndo/nogr obienngeffiotr ftrhormee tyheea prsro. Ejeaccth. year our members complete Dsuesrcvreiybse a wnhdow weilclo pnatritnicuipe atotes e ine

t ahnedm/obre c boemneefmito frreoemn g thaeg epdroajnecdt.l e ss isolated which leads to healthier lives. The number of new and returning members has increased each year. In the past two years we have went from 20 members to 45, and we are projecting over 50 in the coming year. As well, many volunteers have reported that the experience has improved their skills and added to their education. The only change this year is the addition of a hip-hop dance class once a month, which is based on the feedback received from our members.

DSeelseccrti b thee w ahgoe w ofil lt h pea r atuicdipieantcee isn w anhdo/ woril lb beenneefifti t f r foromm t h yeo u prr o pjreocjte.c t. Select all that apply.

Children 0 ? 5 years

Children 6 ? 11 years

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Mmaulneit y Initiatives Fund Co

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Fmirusnti Ntya Intiitoiantsiv es Fund

4

Elementary Students 4

Junior/High School Students

Jan 2017 Jan 2017

Metis

Post--secondary Students

Newcomers to Canada

Community Volunteers

Urban Residents

Nonprofit Board Members/Volunteers

 Children 0 ? 5 years Teens 12 ? 16 years Adults

Children 6 ? 11 years Youth 17 ? 25 years Older adults (55+ years)

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r F a_m__il_y_ ____________________ 3_ _

C_o_m__m_u nity

At what level will the project or event primarily occur?

Individual

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ip c

r i po aje n Fctats m o trail k yee v e pnatr tp irnim thaeri l pyr ocjeccutr??

Community

I n Odnivei-d-tuimale

event

D

a il y F amily

Wee k l

y C ommunity

Monthly

How often will pa3r t Oictiphaenr t_Ts_ w t_a_ikc_ee_ ap__am_rt_o i_nn_ tt_hh_e_ _ p_ro__je_c_t_?_ _________

One--time event

Daily

Weekly

Monthly

How often will parti c

Oiptahnetrs _ t_a_k_e_ p_a_r_t_ i_n_ t_h_e_ p_r_o_j_e_c_t?_ _ __________

One--time eventH ow often will part i

c Dipaialyn t s take part in the proje ct ? W eekly

Co

m

m u

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eesv Feunntd

O Dtahileyr

_5_ _________________ __

W__e_e_k_l_y_ ____ J an 2017

Monthly

Other ________________________________

Project Activities and Timelines

Indicate the primary or major typPerosj oefc t a cAtcivtiivtiietise tsh aant d w Tililm ocecliunre tso

carry out the project and their

aInndtiiccaiptaet tehde s ptarirmt aanryd o ern md adjaotre tsy. p es of activities that will occur to carry out the project and their

Aancttiicviiptya t Deeds sctraiprtt i aonnd

end dates.

Start Date

End Date

OAncetrievcrietayti o Dnaelsevcernitppteiromnon th. Light meal provided

StaDerct 1 D/1a6te

ENnodv

3D0a/t1e7

One hip-hop/break dance class per month. Light meal provided

Dec 1/16

Nov 30/17

Monthly mentorship sessions with the planning committee

Dec 1/16

Nov 30/17

Recruitment/orientation/training meetings and workshops with volunteers

Evaluation meetings held with planning committee, participants and volunteers mid-way through project

Dec 1/16 June 1/17

Nov 30/17 June 8/17

Program evaluation at the end of the project.

Nov 23/17

Nov 30/17

ytythcoshTooouteuumherpagihpmsphtarphiotivlsatjieoettcauceaanesttt.hwripiooeemlvwnalilnspetwohtfrhaitoneatrgnt

Expected Results

Estimate the number of people that willE pxapretcictiepda t Ree asundlt/so r benefit from the project. 60 DEsetsimcraibtee

tthhee

enxupmebcteerd o of u ptecoopmlee tsh, abte nweilfli t psa, r otric riepsautelt s a nthda/to pr a bretniceipfiatn frtos m wi tllh gea pinro frjeocmt.

t heir iDnevsoclrviebme ethnet

ienx tpheec t perdo j oeucttc. o mes, benefits, or results that participants will gain from their involvement in the project. 30-40 Members with disabilities will have access to monthly social and recreational activities as well as monthly hip-hop dance classes. Friendships, increased confidence, and social capacities will increase, all of which contributes to self-reliance and empowerment.

2-3 members with disabilities will build employment and leadership skills though mentorship.

10-20 young adults (primarily individuals without disabilities) will gain experience in community inclusion by assisting with events and forming meaningful relationships with peers with disabilities.

How will you measure and evaluate the overall success of your project? How will you evaluate tHhoew r e wsiulll t yso eux pmeeraiesnucreed a nbdy

peavartliucaiptean tthse?

o

verall success of your project? How will you evaluate Atheq u reessutilotns enxapiereriwenilclebde bcoym paprletticeidpabnytsa?ll

participants at the beginning, midway, and end of the project. This will ask for their feedback on their enjoyment of the activities, but also on how they feel their social skills and inclusion in the community have changed.

We will also hold focus groups three times throughout the year with current and potential members as well as volunteers to discuss how inclusive their schools, workplaces, and public spaces are. This information will help us to determine if members are seeing a change to a more inclusive community, and where more work is needed.

Finally, we will track attendance at each event so we know how many people are attending and returning to our events.

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Community Initiatives Fund

6

Jan 2017

BUDGET INFORMATION

Provide all estimated revenues tBhaUt D wGill E suTp p INorFt OtheR pMroAjeTctI.O InNdi c ate for each applicable

revenue source(s) the budgeted amount and if the revenue is confirmed or pending.

RPreovveinduee a lSl o eustricme(ast)e d revenues that will support the projec$t. A Inmdoicuantte

for eCacohn f airpmpleicda bleP e nding

3 Mrevuennicuipea slo Guorcvee(rsn)m theen tb (uRdMg,eTtoewdn a, Cmitoy)u nt and if the revenue i5s , c5o0n0firmed or pend ing.

PRreovveinnuciea l S Goouvrceern(sm) ent

$ Amount Confirm ed Pend i ng

FMeudneircaipl Galo Gveorvnemrnemnet n t (RM, Town, City)

CProomvimncuinailt Gy o Dveevrenlmopemnte nt Corporation

UFenditeerdal W Gaoyv/eCrnommemnutn ity Foundation CCoormpmoruanteit/yB Duesivneelsosp Smpeonnts oCrosrhpiopr ation

1,100

3

RUengitiestdr a Wtioayn/ FCeoems m unity Foundation

FCuonrpdoraraistien/gB usiness Sponsorship

DReogniasttrioantiso n Fees

OFutnhderra ising CDoomnamtiuonnist y

Initiatives Fund Request

14,500

3

TOothtaelr R evenue Budget

$ 21,100

Community Initiatives Fund Request

PTorotavild Ree avlel n eusteim Bautdegde et x penses for the project. Indicate$ t he expenses that CIF is being

rPerqouviedseteadll teost simupapteodrtE, xapnedn tshees afomrothuentp orof j tehcet. rIenqduiceastte. the expenses that CIF is being requested

EPtoxropsvueipndpseeo a r Ilttl,e eamsntd i mthaeteadm eoxupnDetneossecfrstih pfoetriro etnhq e u e psrto.ject. Indicate the expen$s Eexsp theants e C I F is being $ CIF

SrEetxaqpfuefe n SssateleaIdrtie etmos/ sBuepnpeofritts,

andD ethscer aipmtioounnt of the request.

$ Expense $ CIF

HEStxoapnfefonSrsaaelrai uIrtimesms//B F eeneesf its DPaerstctriimpteioPnro gram Coordinator

$ Expense 7,200 $ C6IF,0 00

ESIntnsattferfur StcaatilonarrmiFeeesne/tsB enefits Hip Hop Dance Instructor

2,000 1,500

PHEnrootnejeorctraat i r Sniuumpmepsnl/iteFse es

DJs for special nights

500

500

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Craft/activity supplies

1,200

400

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e RSnuetpnRptaelilen sta l

AEqduvieprmtiseinngt / RPernotmalo tion Bowling alley, rec centre, other venues for

VFaocluilintyte Reern Rteaacll o gnition weekly activities

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Posters and ad in local newspaper Volunteer appreciation lunch

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1,200

250 250 1,800

1,200

150 0

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approved grant amount are

Teloigtibalel . Expenses Budget Total Expenses Budget

Community Initiatives Fund

Community Initiatives Fund

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