Grant Application

Grant Application Form

* Indicates required field

Legal Charity Organization Name (cheque payable to) *

Project Name *

Main Contact Person *

Title Or Position of Main Contact Person *

Phone Number *

Email *

Website *

Geographical Area Served *

Charity Organization Address *

Total Amount Requested *

Charitable Registration Number *

SECTION B: Summary

Please write a one-page summary of project. Provide background about the issues you hope to address. Include your goals and objectives, inputs, activities, and anticipated outcomes.

Write Your One-Page Summery Here: *

SECTION C: Please provide details as requested in 1-13 below.

1. Describe what is already in place in order to start or continue this project. Who will be facilitating and implementing the project. *

2. Describe the location of the project. Tell us about the vulnerable population in this neighbourhood that need to be served by this project. *

3. Target Group (i.e. specific age ranges among children, adults, seniors, the number of people you plan to reach). *

4. Describe how this project will promote and support the nutritional health of BC residents. *

5. Specific activities that will meet your goals (attach sample one-page curriculum outline if applicable). *

Upload File for Question 5 *

Max file size: 20MB

6. Provide anticipated barriers/challenges to achieve objectives and strategies to overcome them. *

7. Will this project go ahead if NutritionLink Services Society does not fund? *

8. Describe your evaluation plans (include indicators, methods of measurement, and address how the program can be replicated). *

9. Project timeline (should not exceed one page, please attach) Attached: *

Upload File for Question 9 *

Max file size: 20MB

10. Itemized project budget (by quarter, please attach) Attached: *

Upload File for Question 10 *

Max file size: 20MB

11. List of grants received and other funding applications that are still pending decision for this project. *

12. Provide a balance sheet and audited statement of revenue and expense for the most recent completed year. Attached: *

Max file size: 20MB

13. Has your organization applied for a grant from us in the past? Please answer with Yes or No, If Yes, please state which year/s. *

SECTION D: Summary Of Charity Organization

14. Provide a one- page summary of the charity organization’s activities (ie. A summary taken from your organization’s last annual report) *

By signing this application, the Applicant agrees to the terms outlined above.

Organization Name *

Contact Signature *

Date *

Submit