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. *

2. Describe the location of the project and who will be facilitating and implementing the project. Tell us about the vulnerable characteristics 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. Describe the vulnerable population that this project will serve. *

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. Would a representative of your organization be willing to attend an NLS AGM and make a presentation on the progress of your project and the use of NLS funds? *

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

Max file size: 20MB

14. 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

13. 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