Fillable Strategic Plan Grant Application Form SECTION 1. CONTACT

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Strategic Plan Grant Application Form SECTION 1. CONTACT

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Finance
1 Centennial Square
Victoria, BC V8W 1P6
E grants@victoria.ca
Strategic Plan Grant
Application Form
City of Victoria | STRATEGIC PLAN GRANT APPLICATION FORM 2
SECTION 1. CONTACT INFORMATION
Organization Name:
Mailing Address:
Contact Person: Email:
Telephone: Website:
SECTION 2. CONTACT INFORMATION – NEIGHBOURHOOD GROUP
Please note: This section is only applicable to those applying on behalf of a neighbourhood group.
Name:
Mailing Address:
Telephone: Email:
SECTION 3. ORGANIZATION INFORMATION
Are you registered under the Society Act? Yes No Society Registration Number:
Are you a registered Charity? Yes No Charity Registration Number:
*Must provide society number and Certificate of Good Standing or Charity Registration Number and CRA Canadian Registered Charities Details Page
showing charity status as registered
Organization mission/mandate (500 characters max – do not add extra pages)
Brief history and role in benefitting residents of Greater Victoria (500 characters max – do not add extra pages)
How many paid staff at organization? Full Time: Part Time:
How many volunteer staff at organization? Total volunteer hours:
Can the program run under current COVID-19 Provincial Health Orders? Yes No
If the answer is yes, please explain how your program will accommodate the current orders. (max of 750 words – do not add extra pages)
SECTION 4. ORGANIZATION FINANCIAL INFORMATION
Has the organization filed for bankruptcy or currently seeking credit protection? Yes No
Did your organization receive a grant from the City of Victoria in the prior year?
Yes No
If yes, has the Final Report been completed?
Yes No
Only those organizations that have submitted a complete Final Report
for evaluation will be considered for new funding.
Finance
1 Centennial Square
Victoria, BC V8W 1P6
E grants@victoria.ca
Strategic Plan Grant
Application Form
City of Victoria | STRATEGIC PLAN GRANT APPLICATION FORM 3
Please list a summary of all sources of funding you receive and how is it used in your organization's annual budget. Also include all
pending grant requests.
Funding Sources
$ Amount
Use
City of Victoria
Organization's Annual Budget
SEC
TION 5. PROJECT OR PROGRAM KEY OBJECTIVES
What are the project or program key objectives and how will the organization measure success? This criteria will be used on the Final Report
to measure the success of the project or program’s objectives and the External Grant Review Committee will be evaluating based on the
success using these measures.
Objective
Measure of Success
SECTION 6. PROJECT OR PROGRAM INFORMATION
When completing this section, please note the External Grant Review Committee will take into consideration the following:
1. Council’s Weighted Strategic Plan Objectives
2. Weighted Assessment Criteria
a. Capacity of an organization to deliver the project (20%)
b. Evidence of need (20%)
c. Project Builds Community Resilience (30%)
d. Project feasibility (30%)
Project or program title:
Who is your target audience?
Brief description of the project or program and why the grant is needed. (1250 characters max – do not add extra pages)
$ 0.00
Finance
1 Centennial Square
Victoria, BC V8W 1P6
E grants@victoria.ca
Strategic Plan Grant
Application Form
City of Victoria | STRATEGIC PLAN GRANT APPLICATION FORM 4
Select the weighted Strategic Plan Objective that the project or program aligns with or supports (for further explanation of the objectives
and outcomes, refer to the 2019-2022 Strategic Plan
).
□ Affordable Housing (5.88)
□ Prosperity and Economic Inclusion (5.88)
□ Climate Leadership and Environmental Stewardship (5.38)
□ Reconciliation and Indigenous Relations (5.38)
□ Strong, Liveable Neighbourhoods (5.25)
□ Health, Well-Being and a Welcoming City (5.00)
□ Sustainable Transportation
(4.75)
If you have selected more than one weighted Strategic Plan Objective, we encourage applicants to select the primary objective that
the project or program aligns with or supports.
□ Affordable Housing (5.88)
□ Prosperity and Economic Inclusion (5.88)
□ Climate Leadership and Environmental Stewardship (5.38)
□ Reconciliation and Indigenous Relations (5.38)
□ Strong, Liveable Neighbourhoods (5.25)
□ Health, Well-Being and a Welcoming City (5.00)
□ Sustainable Transportation
(4.75)
Explain in detail how this project or program will meet and support the chosen City of Victoria’s Strategic Plan objective.
(1250 characters max – do not add extra pages)
How did you consider the impact of the under-served communities in the development of your program?
(1250 characters max – do not add extra pages)
How does the program advance Council’s state values on equity?
(1250 characters max – do not add extra pages)
How does this program building community capacity and empower communities most impacted by inequities?
(1250 characters max – do not add extra pages)
Finance
1 Centennial Square
Victoria, BC V8W 1P6
E grants@victoria.ca
Strategic Plan Grant
Application Form
City of Victoria | STRATEGIC PLAN GRANT APPLICATION FORM 5
How many people participate in or take advantage of the program for which you are seeking funding?
How many of those people live within the boundaries of the City of Victoria?
How many of those people live outside the City of Victoria but within the boundaries of the Capital Regional District?
How many will benefit from the project or program? Please explain below.
(1250 characters max – do not add extra pages)
SECTION 7. PROJECT OR PROGRAM BUDGET
In 2020, Council approved $592,285 in Strategic Plan Grant awards ranging from $1,500 to $32,500 with the average grant awarded of
just under $10,000
.
Total project or program amount requested: $
Must equal Total Funding Sources from City of Victoria on page 6
Prepare a detailed breakdown of all budget expenses and funding sources below – do not add extra pages.
BUDGET EXPENSES
$ Amount
Details (if applicable)
Project or Program Costs
A. Total Project or Program Expenses
Administration
B. Total Administrative Expenses
TOTAL PROGRAM EXPENDITURES (A+B)
Should equal Total Program Funding Sources on page 6
Administrative costs are capped at a maximum of 18% of total
budget.
Total percentage of administrative costs
$ 0.00
$ 0.00
$ 0.00
0.00%
Finance
1 Centennial Square
Victoria, BC V8W 1P6
E grants@victoria.ca
Strategic Plan Grant
Application Form
City of Victoria | STRATEGIC PLAN GRANT APPLICATION FORM 6
BUDGET FUNDING SOURCES $ Amount Pending or Confirmed Contact Person Phone Number
Government Funding - include pending requests
City of Victoria
A. Total Government Funding
Corporate Sponsorships
B. Total Corporate Sponsorships
Matching Funds
C. Total Matching Funds
In-Kind Contributions
D. Total In-Kind Contributions
Waived Fees and Charges
E. Total Waived Fees and Charges
TOTAL PROGRAM FUNDING SOURCES
(A+B+C+D+E)
Should equal Total Program Expenditures on page 5
Partial funding may be available. Will the project occur without full funding by the grant? Yes No
If you do not receive full funding, what is the impact to the organization and project or program. Please provide an explanation below.
(500 characters max – do not add extra pages)
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Finance
1 Centennial Square
Victoria, BC V8W 1P6
E grants@victoria.ca
Strategic Plan Grant
Application Form
City of Victoria | STRATEGIC PLAN GRANT APPLICATION FORM 7
What is the minimum level of funding required for the program or project to occur? Please provide an explanation below.
(500 characters max – do not add extra pages)
SEC
TION 8. PROJECT OR PROGRAM TIMELINE
To be eligible, projects or programs must be substantially completed within July 1 to the following June 30 each year.
Project or program dates From: To:
Project or program location:
Project or program timeline and major milestones.
Date
Milestone
SECTION 9. PROJECT OR PROGRAM VOLUNTEERING
How many volunteers will work on this project or program? Total volunteer hours required:
Can the project or program occur without volunteer support? Yes No
SECTION 10. PUBLIC ACKNOWLEDGEMENT
All grant recipients are required to publicly acknowledge the grant. How does your organization plan on publicly acknowledging the City’s
funding support?
Website
Newspaper Advertisement
Social Media
Newsletter
Sponsor Plaque
Annual Report
Other:
SECTION 11. DECLARATION
I am an authorized signing officer of the organization and I certify that the information given in this application is correct. I agree to the
following terms:
•
The organization will be in compliance with all
applicable municipal policies and bylaws
•
The organization will publicly acknowledge the grant
awarded by the City
•
The organization is in good standing with either: (1) the
Province of BC as a registered Society or (2) the
Canada Revenue Agency as a registered Charity
•
The organization is not in arrears with the City
•
The organization is not in bankruptcy or seeking
creditor protection
•
The grant application meets all the eligibility
requirements of the City’s Grant Policy
Signature Position
Name Date
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Strategic Plan Grant Application Form SECTION 1. CONTACT

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Completed 6 January 2021

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