FUNDING APPLICATION FORM

Transcription

1 FUNDING APPLICATION FORM LOCAL COMMUNITY EVENTS Please contact the QLDC Events Office to discuss your event PRIOR to completing this application form. Please also ensure that you: Read the Events Strategy which are provided on the QLDC Website. All Applications must be submitted digitally you must complete this form, save and return via to All the supporting documentation as per the checklist in section six of this application form must also be submitted digitally via to DO NOT WRITE See Attached as an answer to any question in this Application Form. If there is insufficient room, please provide a summary on the application form in the box provided, and provide further details if necessary as part of your supporting information. If however your application is incomplete when received by our office, it may be returned to you, which will inevitably delay any decision. Queenstown Lakes District Council Tel: Gorge Road Private Bag Queenstown events@qldc.govt.nz Page 1 of 10

2 1. APPLICANT INFORMATION 1.1 Contact Details Name of Organisation Contact Name Title Address Telephone Mobile Website 1.2 Organisation Details a. How long has your organisation been in existence (tick): Less than 1 year 2-3 years 4-5 years More than 5 years b. Legal Status of Applicant (tick): Charitable Trust Incorporated Society Limited Liability Company Other (please specify): c. Taxation Status of Applicant (tick): Tax Exempt Organisation Tax Paying Organisation n-profit Organisation Other (please specify): d. Is Applicant/Organisation GST Registered (tick): e. Event Organiser / Owner / Promoter (if different from Funding Applicant): Name of Organisation Contact Name Title Address Telephone Mobile Website Page 2 of 10

3 f. Does the event owner/organiser have previous experience in event management (tick): If yes, please detail past events, outline key objectives and outcomes illustrating success of events and accomplishments (up to 200 words - attach additional information as required): Page 3 of 10

4 2. EVENT INFORMATION 2.1 Name of Event: 2.2 Event Summary: Please describe your event and outline what you believe makes it great (up to 200 words - attach additional information as required): 2.3 Event Objectives: Please outline the main reasons this event is being held and your objectives as the Event Manager/Promoter (up to 200 words - attach additional information as required): 2.4 Date(s) of Event: From 2.5 Event Duration (Days): 2.6 Has the Event been held before (tick): If, when, where and how successful was the event (please provide detail backed by references/ testimonials where available (up to 200 words - attach additional information as required): 2.7 What is the frequency of the event (tick): Annual (every year) Biennial (every two years) A one-off Event A limited season event (e.g. every year for three years only) Other Specify: To Page 4 of 10

5 Where will the event be held: Please specify town(s) (tick): Arrowtown Hawea Makarora Wanaka Please specify Venue(s) (tick): QLDC Venues Arrowtown Athenaeum Hall Lake Wanaka Centre Queenstown Memorial Centre Gardens and Green Spaces Queenstown Earnslaw Park Queenstown Village Green Queenstown Recreation Ground Lake Hayes Show Grounds Arrowtown Butlers Green Library Green Millbrook Corner Wanaka Wanaka Station Park Dinosaur Playground Allenby Park Glenorchy Kingston Queenstown Other Specify: Lake Hayes Pavilion Queenstown Events Centre St Omer Park Queenstown Gardens Jacks Point Field Buckingham Green Jack Reid Park Pembroke Park Wanaka Recreation Reserve Peter Fraser Park in Lake Hawea Streets and Other Public Spaces Specify: Please provide route/course maps where appropriate Other Specify: 2.10 Please advise what plans are currently in place for the event (please note, all plans must be made available on request) Event Delivery Plan Business Plan Marketing Plan Budget and Financial Forecasts Health & Safety Plan Traffic Management Plan Waste Management Plan Contingency Plan Risk Mitigation Plan Crisis Management Plan Other (please specify): tes: Page 5 of 10

6 3. FUNDING INFORMATION 3.1 What is the total projected event expenditure: 3.2 What is the total projected event revenue: (excluding any QLDC funding or in-kind support) 3.3 What is the amount sought from QLDC: (amount sought cannot exceed 25% of total budget expenditure) 3.4 If successful, please list and describe specific event expenses/costs to which QLDC funding will be applied (up to 200 words): 3.5 Please outline the event income structure: Funding Agency/Supporter Value Dollar value of event income from outside the district? Event expenditure within district? Dollar value of event income from users/attendees/participants? Dollar value of event income from ticket sales? Dollar value of event income from sales at event (food stalls, alcohol, merchandise, etc.) Dollar value of event income from Sponsorship (cash and in-kind)? Dollar value of event income from donations/patrons (no "strings attached")? Dollar value of event income from funding agencies (local/regional/national) Dollar value of event income from QLDC funding/in-kind support? Dollar value of event income from other sources? 3.6 What Grants/Community Funding/Central Government support (cash and in-kind) has been sought and/or confirmed for the event. (please specify names of supporters and dollar values sought/confirmed): Funding Agency/Supporter Cash Value In-Kind Value Confirmed (Y/N) Page 6 of 10

7 3.7 What sponsorship (cash and in-kind) has been sought and/or confirmed for the event. (please specify names of sponsors and dollar values sought/confirmed): Sponsor Cash Value In-Kind Value Confirmed (Y/N) 3.8 Are you receiving any QLDC support towards this event (e.g. Annual Plan Funding, Commercial Ratepayer Funding): If, please explain (up to 200 words): Please note you must provide a full and complete budget for the event in order for your application to be considered Page 7 of 10

8 4. SOCIAL AND COMMUNITY BENEFITS 4.1 How many volunteers are involved with your event and where do they come from: Origin Number of Volunteers Local Within District Regional (300km Radius) National International Total: 4.2 What benefits does this event provide or generate for the local community and surrounding district (up to 200 words): 4.3 Does the event promote high achievement and participation for residents in any of the following fields (tick): Arts/Culture Sporting Leisure Other Specify: 4.4 Does the event profile New Zealand or regional culture and heritage and is this cultural heritage unique (tick): If yes, please explain (up to 200 words): Page 8 of 10

9 4.5 Does the event provide a programme of activities that allows for local participation, provides educational opportunities or showcases local achievements: If yes, please explain (up to 200 words): 4.6 Please outline what you believe to be the legacy of this event for the local community (pride, identity, participation, economy (up to 200 words): 5. ENVIRONMENTAL IMPACT 5.1 Describe what efforts are being made towards minimising the impact of this event on the environment and making the event more environmentally sustainable. Consider energy and water conservation, returning the site after the event, waste management, recycling, noise, traffic management, etc. (up to 200 words): Page 9 of 10

10 6. SUPPORTING MATERIAL Please ensure you have provided the following supporting information with your application. All documents are to be transmitted electronically. Certificate of Incorporation / Trust Deed (if you have submitted this with a previous application and there have not been any changes, we do not require this again) Information about people involved in the Project List committee members and/or key event staff and their roles and relevant experience Previous Outcomes If the event has been staged before, please provide details of key outcomes and achievements, event photos, reports (economic impact, event surveys, ASR), audited financial accounts and testimonials. Any Letters of Support from key stakeholders, suppliers and sponsors Quotes for Service where funding is to be allocated to specific costs Copy of QLDC Hire Agreement (if available) Copy of QLDC Resource Consent and Permits (if applicable) 7. STATUTORY DECLARATION Please print, sign, scan and return this page with your application. The Chairman, CEO or authorised representative of the Event Organiser shall execute this Statutory Declaration that the information contained in the Application is true and correct in all respects. I/We Full Name of Declarant(s) Of Address of Declarant Position in Organisation Name of Organisation Confirm that Name of Organisation Has formally applied for funding under Queenstown Lakes District Council s Event Fund and I confirm and warrant that to my knowledge the details set out in the Application are true and correct in all respects. Signature Page 10 of 10