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General

Grant Request - Non profit Organisation

Open to Westmount-based not-for-profit organisations.

Deadline: November 30

About the Organisation

Organisation name•

Organisation website

Organisation address

Public way (street, avenue, road, etc.)•

Civic number•

Contact Person

First name•

Last name•

Title or function•

Email•

Phone number•

Organisation Details

Organisation type

Incorporation date

Legal status of the organisation•

Revenue Canada registration number•

Organisation mission or mandate•

Organisation history•

Board of directors—information on member 1

Full name

Title

Paid staff—information on employee 1

Full name

Title

NUMBER OF VOLUNTEERS

Services Offered and Reach

Services offered to the community•

Outline the services, programmes and events presently offered to the community.

Anticipated participation in the next year

Residents•

Non-residents•

Impacts•

What will be the positive impacts for the organization if the grant is provided?

Recognition•

How will the City's contribution be recognized by the organisation?

Financial Information

Organisation's fiscal year•

Budget•

Provide budget details, including audited financial statements where applicable, outlining the need for funding by the City. Please indicate if documents will be attached at the end of the form or provided by other means.

Development•

Provide details outlining the short and long term development plans of the organization and its services, including anticipated sources of future funding.

Has your organisation ever received a grant from the City of Westmount?•

Yes

Grant Request

Supporting grant—details for request 1

Amount requested

Programme details

Attachments

Please attach to this application:
1) current financial statement
2) current liability insurance policy
3) description of the organisation's short- and long-term development plan

Drop files here or click to upload them.

Declaration and signature

By checking this box, I certify that all information submitted herewith in support of this grant request is, to the best of their knowledge, accurate and complete •

By checking this box, I certify that The organisation's executive committee has approved this request. •

By checking this box, I certify that I occupy a senior position (General Director, President or Treasurer) that authorises me to sign this grant application on behalf of the organisation. •

By checking this box, I declare that I have read the City of Westmount's policy statement on grants.

•

Signature •

Please enter your first and last name.

Date

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