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2019-20_Application Form_Major Project Grant MUNICIPALITY OF THE DISTRICT OF CHESTER GRANT APPLICATION FORM Major Project Grant Request Name of Organization Applying Contact Person Position with Organization Mailing Address Incorporation Number with Registry of Joint Stocks (if applicable) Phone: Fax: Email: Date: Signature of Signing Officer(s) and their position with Organization: Name Signature Position _______________________________________ _______________________________________ ___________________________________ _______________________________________ _______________________________________ ___________________________________ ORGANIZATION INFORMATION: 1. Purpose or objective(s) of your organization (i.e. mission statement): __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ 2. Is your project: New Construction ______ Renovation ______ Large Capital Equipment ______ 3. Please describe your project and its benefits to residents (attach separately if insufficient space). __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ 4. If your project is new construction or renovation, who are the main users of the facility and for what purpose will they use it? ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ 5. How much money are you requesting? $__________________________________________ 6. Budget  Please attach a project budget showing all revenue and expenses.  The budget must include all sources of revenue.  Please include a copy of your most recent annual financial statement. 7. For construction or renovation projects, please specify whether you own the facility or have a long- term lease. __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ 8. Is there additional information that may support your grant application? Please attach letters of support, etc. __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ 9. Did your organization receive funds last year from the Municipality of the District of Chester? Yes _____ No _____ If yes, was it a Council Grant _____ Recreation Grant _____ Tourism Grant _____ How much was the grant? $___________________________________ (Attach copy of report if not previously submitted) Application Checklist: DID YOU INCLUDE WITH YOUR APPLICATION: ____ A written outline of the project and its benefits to residents ____ Project budget including Revenues and Expenses ____ Previous Years Financial Statement ____ Incorporation Number (if applicable) ____ Application signed by signing officer(s) ____ Copy of report regarding previous year’s grant (if a grant was received last year) If you require assistance, please contact the Municipal Office at: Phone (902) 275-3490 Fax (902) 275-3630 Email chaughn@chester.ca REPORT TO COUNCIL Following the completion of your project it is requested that you provide a very brief report regarding the project and how the Grant money was spent. If a follow-up report is not received future requests may be affected. Please forward applications and reports to the following: Director of Recreation & Parks “Grant Report” Municipality of the District of Chester PO Box 369 Chester NS B0J 1J0