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.

APDF — Grant Application

STEP 1 - APPLICANT DETAILS

ORGANISATION NAME (required) NEW ZEALAND CHARITY REGISTRATION NUMBER (CRN) (required)

ORGANISATION PRIMARY ADDRESS (required) Country Address Line 1 (required) Address Line 2

City (required) Postcode (required)

APPLICANT WEBSITE ADDRESS / INSTAGRAM / TIKTOK (required — at least one)

Enter at least one link (Website, Instagram, or TikTok). Use a full URL starting with http:// or https://

Website (URL) Instagram (URL) TikTok (URL)

PRIMARY CONTACT (required)

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

First Name Last Name

POSITION HELD IN ORGANISATION (required)

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

PRIMARY CONTACT PRIMARY PHONE NUMBER (required)

Country Number

PRIMARY CONTACT EMAIL ADDRESS (required)

SECONDARY CONTACT (required)

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

First Name Last Name

SECONDARY CONTACT EMAIL ADDRESS (required)

STEP 2 - ADDITIONAL DETAILS

WHAT IS YOUR ORGANISATION'S MISSION STATEMENT? (required)

Brief explanation on who you are and why your organisation does what it does.

PLEASE PROVIDE A SHORT SUMMARY OF WHAT THIS APPLICATION FUNDING IS FOR (required) PLEASE OUTLINE THE STEPS TO ACHIEVE THE GOALS (required) — If not relevant, note “n/a”

If relevant, note n/a if not relevant.

BOARD / MANAGEMENT TEAM - NAMES AND TITLES (required) TOTAL AMOUNT REQUESTED (NZD) (required)

STEP 3 - SUPPORTING INFORMATION

BANK ACCOUNT NAME (required) BANK ACCOUNT NUMBER (required)

ATTACH PROOF OF BANK ACCOUNT (PDF only, required)

+ Add a File

PLEASE ATTACH ANY OTHER SUPPORTING DOCUMENTATION (PDF only, optional)

For example, details of community supporters who can support your application.

+ Add a File

WHAT REGION/S WILL THE FUNDING BE USED? (required) WHAT ARE THE PRIMARY AREAS OF FOCUS FOR THIS APPLICATION? (required)

ARE YOU PROVIDING A BUDGET TO SUPPORT YOUR APPLICATION? (required)

YES – will provide as attachment NO BUDGET PROVIDED

PLEASE UPLOAD A COPY OF YOUR MOST RECENT ANNUAL REPORT (PDF only, required)

+ Add a File

PLEASE UPLOAD A COPY OF YOUR CURRENT FINANCIAL ACCOUNTS (PDF only, required)

+ Add a File

STEP 4 - OTHER FUNDING

PLEASE PROVIDE DETAILS OF PAST FUNDERS FOR THIS PROJECT (required)

Organisation name and amount applied for.

HOW MUCH MONEY HAVE YOU RAISED OUTSIDE OF THIS APPLICATION? (NZD) (required) HOW MUCH MORE FUNDING IS NEEDED (EXCL. THIS APPLICATION) (NZD) (required)

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. (required)

SIGNATURE (type full name) (required)

Please type your full name here.

NAME OF AUTHORISED PERSON (required)

First Name Last Name

POSITION (required)

Country PHONE NUMBER (required)

EMAIL (required)

APPLICATION FORM

Before proceeding, please conﬁrm the following:

STEP 1 - APPLICANT DETAILS

STEP 2 - ADDITIONAL DETAILS

STEP 3 - SUPPORTING INFORMATION

STEP 4 - OTHER FUNDING

STEP 5 - DECLARATION

Thank you!