APPLICATION FORM

Before proceeding, please conﬁrm the following:

Is your organisation a registered New Zealand charity?
Is your organisation New Zealand based, and funds will be used in New Zealand?
You can provide a New Zealand bank account in the organisations name
Can your organisation demonstrate stable ﬁnancial viability
You are aware that producing receipts, accountability reports and an audio visual/written presentation (within six months) regarding the use of funds are conditions of receiving a grant.
You agree to the APDF promoting the granting of the award across its social media platforms.

STEP 1 - APPLICANT DETAILS

ORGANISATION NAME

NEW ZEALAND CHARITY REGISTRATION NUMBER (CRN)

ORGANISATION PRIMARY ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

APPLICANT WEBSITE ADDRESS/ INSTAGRAM/TIK TOK

http://

PRIMARY CONTACT

This is the person we will correspond with about this grant.

First Name

Last Name

POSITION HELD IN ORGANISATION

e.g. Manager, Director, or Fundraising Coordinator.

PRIMARY CONTACT PRIMARY PHONE NUMBER

Country

(###)

###

####

PRIMARY CONTACT EMAIL ADDRESS

SECONDARY CONTACT

This is the person we will correspond with about this grant.

First Name

Last Name

SECONDARY CONTACT EMAIL ADDRESS

STEP 2 - ADDITIONAL DETAILS

WHAT IS YOUR ORGANISATION'S MISSION STATEMENT?

Brief explanation on who you are and why does your organisation do what you do?

PLEASE PROVIDE A SHORT SUMMARY OF WHAT THIS APPLICATION FUNDING IS FOR

PLEASE OUTLINE THE STEPS YOU WILL BE TAKING TO ACHIEVE THE GOALS YOU HAVE SET OUT IN YOUR SUMMARY ABOVE

If relevant, note n/a if not relevant

PLEASE PROVIDE INFORMATION ON YOUR BOARD/MANAGEMENT TEAM - NAMES AND TITLES

BANK ACCOUNT DETAILS

TOTAL AMOUNT REQUESTED

STEP 3 - SUPPORTING INFORMATION

BANK ACCOUNT NAME

BANK ACCOUNT NUMBER

WHAT REGION/S WILL THE FUNDING BE USED?

WHAT ARE THE PRIMARY AREAS OF FOCUS FOR THIS APPLICATION?

ARE YOU PROVIDING A BUDGET TO SUPPORT YOUR APPLICATION?

YES - will provide as attachment

NO BUDGET PROVIDED

STEP 4 - OTHER FUNDING

PLEASE PROVIDE DETAILS OF PAST FUNDERS FOR THIS PROJECT

ORGANISATION NAME, AND AMOUNT APPLIED FOR

HOW MUCH MONEY HAVE YOU RAISED FOR THIS PROJECT OUTSIDE OF THIS APPLICATION?

HOW MUCH MORE FUNDING DO YOU NEED TO RAISE TO COMPLETE THE PROJECT EXCLUDING THIS APPLICATION'S VALUE?

STEP 5 - DECLARATION

This section must be completed by an appropriately authorised person on behalf of the applicant organisation.

I certify that to the best of my knowledge the statements made within this application are true and correct, and I understand that if the applicant is approved for this grant, we will be required to accept the terms and conditions of the grant as outlined in the letter of approval.

I AGREE

SIGNATURE

Please type your full name here

NAME OF AUTHORISED PERSON

First Name

Last Name

POSITION

PHONE NUMBER

Country

(###)

###

####