2018 Sustainable Organization Grant Application

PART 1: REGISTRATION FORMName of organization     Charitable registration number (if applicable)     Name & position of contact person     Mailing AddressStreet 1      Street 2      City       Prov       Postal Code      Phone       Email      Website      

Project Name:     Project Objective(s) (max 30 words)     Total project budget: Amount requested from ACU (max 75%):           

Is your organization a member of Assiniboine Credit Union? Yes     No

If yes, what branch?     

DeclarationPlease confirm the following statements by placing a checkmark beside them:

I have read and understand the Sustainable Organization Grants guidelines and eligibility criteria.

Our organization has not already received a Sustainable Organization Grant in 2018.

We have submitted a final report for any previous grant received from ACU.

I am authorized to make an application of behalf of this organization.

     Name & Position

     Date

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2018 Sustainable Organization Grant Application

PART 2: ORGANIZATIONAL INFORMATIONWhat is the mission/purpose of your organization?     Year founded     Your organization has the strongest fit with which ONE of the following focus areas?

Community Inclusion Environmental Sustainability Community Enterprise Development

Describe your core activities (maximum 300 words)     What is your total annual operating budget?      What are your major sources of funding?     

Number of Employees: Number of Volunteers:           

Is the primary purpose of your organization to benefit a marginalized community? Yes     No

If yes, which community?     Is there other information you would like to add about your organization? (maximum 200 words)     

PART 3: PROJECT INFORMATIONThis application is for (check ONE only)

Equipment Planning Public Awareness Professional Development

Describe your project     

Why have you decided to undertake this project and how will it help your organization become more sustainable?     

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2018 Sustainable Organization Grant Application

What skills and resources does your organization bring to this project/program to ensure its success?      How will you measure the project’s success?     

Project start date Estimated completion date           

PART 5: ATTACHMENTSPlease attach the following documents to your application:

Project budget (please indicate if other funding is confirmed or pending) List of current Board of Directors and year appointed Most recent annual report and year end financial statements

Optional:

Documentation relating to the project costs (e.g. estimates for equipment purchase, consultant’s resume, information about training program)

Send your completed application package

By email to ncolledge@assiniboine.mb.ca

Or mail hard copy to:Community Grants CoordinatorAssiniboine Credit Union200 Main StreetBox 2, Station MainWinnipeg, MB R3C 2G1

Please note that all questions in the application form must be answered on this application form and all the documents listed above must be included with your submission. Incomplete applications will not be considered for funding.

Questions?Contact Nan Colledge, Community Grants CoordinatorTel: (204) 258.3464email ncolledge@assiniboine.mb.ca

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2018 Sustainable Organization Grant Application

Help us to help youHow did you hear about ACU’s Sustainable Organization Grants Program? (check all that apply)

ACU Website In-Branch Asterisk Newsletter Another Community

Organization Word of Mouth Community List Serve

Another Website Social Media Other (specify)      

Was this grant application easy to understand? Yes No

Was this grant application easy to use? Yes NoDo you have suggestions or comments about improving the application form or the process?      

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