APPLICATION FOR ASSISTANCE

 

Please complete all Sections.  RETURN ORIGINAL TO:
Please print or type. S’PORT FOR KIDS FOUNDATION  (905) 886-4392

175 West Beaver Creek Road, Suite 6  RICHMOND HILL, ON  L4B 3M1

DATE:   ________________________

 

1.  NAME OF ORGANIZATION / APPLICANT: 

_________________________________________________________________________________
      Name          Phone #     
 

_________________________________________________________________________________
      Address         
 

_________________________________________________________________________________
      City  Province Postal Code

   

2.  NAME OF PRIMARY CONTACT PERSON (If Different From Above) 

 
__________________________________________________________________________________ 
Name Position           Phone #  

       

 

    

3.  FINANCIAL ASSISTANCE REQUESTED

$___________________________           

______________%


   As a percentage of the total budgeted expenditures for the current year  

 

4.  DATE REQUIRED:

 _________________________________________________________________________________

5.  HAS THE ORGANIZATION/APPLICANT REQUESTED FUNDING ASSISTANCE IN THE
     LAST TWELVE MONTHS FROM ANY OTHER SOURCE, FOUNDATION, MUNICIPAL,
     PROVINCIAL OR FEDERAL GOVERNMENT, SPORTS GOVERNING BODY

                   

            NO __________________________                       YES  _____________________________

                                              (If Yes, please complete the following)

From Whom Date Amount Amount Refused
Requested

 		Requested

 		Requested

 		Received
______________________      

 __________    

 __________   

 _________   

   ___________

 
______________________       __________ __________ _________ ___________
 

 

6.  WHAT IS THE NATURE OF THE SUPPORT REQUESTED? 

 

____________________________________________________________________________
 

____________________________________________________________________________

 

____________________________________________________________________________

 

____________________________________________________________________________

 

7.  IS IT ANTICIPATED THAT THE ORGANIZATION / APPLICANT MAY REQUEST 
     FINANCIAL ASSISTANCE FROM THE FOUNDATION DURING THE NEXT TWO YEARS? 

NO ________________________                YES ________________________  

   

(If Yes, please provide a reasonable projection of your requirements over the next two years.)

__________________________________________________________________________________

 

  8.  PLEASE INCLUDE THE FOLLOWING:

  (i)     copy of the most recent Financial Statements
  (ii)    copy of current budget
  (iii)   other pertinent information

____________________________________________________________________________________________

We certify that, to the best of our knowledge, the information provided in this Application for Financial 
Assistance is accurate and complete and endorsed by the organization which we represent.
 
____________________________        ___________________________       ____________________
Name Title Date
 
____________________________        ___________________________       ____________________
Name Title Date

 Note: Parent, Guardian or Community Representative must sign if applicant is under 18 years of age.

 _____________________________________________________________________________________

OFFICE USE ONLY

DATE RECEIVED:  _______________________    DATE PROCESSED:  ______________________