Step 1 of 6 16% The 2021 Community Impact Grant Application period is open. Before you begin...We’ll need to know a little about your organization Provide details of the specific program you are seeking funding for At the end of your application you will need to upload the following documents: A list of current executive/board members Most recent audited financial statements and annual report Itemized budget for the program Optional: additional supporting materials including marketing, collateral, audio/visual to support your application. The last day to fill in and submit this application is August 31st. Please note that only successful applicants will be contacted. Do you have additional questions? Please see our FAQ page or contact us here for more info. You can save your progress and resume your submission at a later date if required. Qualification QuestionsAre you a current registered Canadian charity?* Yes No Sorry you are not eligible to apply for a grant at this timeIs this grant being applied for a specific program?* Yes No You may only apply for the grant if it will be used for a specific programHave you previously received a grant from Ecclesiastical Insurance?* Yes No Do Not Know Organization InformationCRA Business Number #*15 digits in format 000000000RR0000 Registered Legal Name of Charity* Operating Name of Charity* Address* Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Website* Year Founded* Current Annual Operating Budget ($)* Contact InformationPrimary Contact Name* First Last Position Title* Phone Number*Phone Extension Email* Secondary Contact Name* First Last Position Title/Relation to Charity* Phone Number*Phone Extension Email* Please review your inputs for accuracy before proceeding to the next stage. Organization Background/History You may use the upload feature at the end to include additional information if required.What is your vision and mission?*What type of programs or work do you undertake?*Please provide facts, data or metrics to demonstrate your reach or effectiveness.*Which of the following groups do you support?* Youth Vulnerable/underrepresented groups Canada's history and culture Please provide an overview of how your organization supports the group(s).*Program DetailsName of Program* When did / does your program intend to start?* Does your program have an end date? If so, when? Program Purpose, Objectives, and Goals*Describe the target audience of the program. Approximately how many people will benefit as a result of the program?*Program Key Activities / Timeline*How will you determine the success of your program?*What is the ongoing sustainability/long-term impact you see of this program?*Please review your inputs for accuracy before proceeding to the next stage. Grant RequestGrant amount requested ($)*Our typical grant size ranges from $10,000 to $25,000. Total annual operating cost of the program ($)* Will this grant fund the entire program or an element of the program?* Funding the entire program Funding an element of the program Please provide additional details and identify all other funding for the program*Please describe how you would acknowledge a grant from Ecclesiastical Insurance and Allchurches Trust Limited (ATL).*Please review your inputs for accuracy before proceeding to the next stage. Declaration and ConsentThis declaration and consent are required for all grant applications submitted to Ecclesiastical Insurance Office plc “Ecclesiastical Canada”. This declaration and consent must be made by a person from the organization submitting the Grants application who has appropriate authority (such as Chief Executive Officer, Director, Chairperson or President) to declare and consent to the matters required. In my capacity with the organization, I declare that: (please select Yes or No)The answers given and statements made in this application are to the best of my knowledge true and complete, and that I have not withheld any information likely to affect the accuracy of this application.* Yes No Ecclesiastical Canada will be notified of any change to details provided, and any circumstance that may affect the accuracy of this application.* Yes No On behalf of the organization for which this application is made, I support the grant being sought and the program as outlined. I am aware of and agree to the grantee obligations.* Yes No If our organization is successful, I understand that before any grant is issued, we will be provided with a Grant Acknowledgment Form that outlines grantee obligations and provisions.* Yes No I understand that grant funds may only be used for the program for which the grant has been awarded. I acknowledge that any grant funds that are unexpended at the end of the Grant Period, must be promptly returned to Ecclesiastical Insurance, unless formal approval has been provided by Ecclesiastical Canada to carry forward the unexpended funding for a continuing program.* Yes No Privacy Policy* I have read Ecclesiastical Canada’s Privacy Policy, and noted that it applies to all personal information collected for the purposes of the grant application process. I give consent for the use of such information as required; to enable details of the Community Impact Grant Application to be confirmed, and to facilitate the processing of the application by Ecclesiastical Canada. I consent to Ecclesiastical Canada contacting any relevant persons or organizations about the application. I also consent to providing copies of the application to such third parties as may be necessary from time to time.* Yes No I understand and agree that Ecclesiastical Canada reserves the right to promote and detail the grant program details for its own marketing and reporting purposes. If my organization undertakes any marketing or promotional activities, I agree that any published or display materials for the program will include Ecclesiastical Canada's logo and/or acknowledgment of grant support.* Yes No Ecclesiastical may invite you to attend a focus group to identify how we can make our program better for you and your charity.Name of Person in Authority* First Last Position Title* Signature*Please review your inputs for accuracy before proceeding to the next stage. Related DocumentsPlease upload list of executive committee/board members* Drop files here or Select files Accepted file types: pdf, xls, xlsx, doc, docx, txt, jpg, jpeg, Max. file size: 50 MB. Please upload most recent audited financial statements and annual report* Drop files here or Select files Accepted file types: pdf, xls, xlsx, doc, docx, txt, jpg, jpeg, Max. file size: 50 MB. Please upload itemized budget for program* Drop files here or Select files Accepted file types: pdf, xls, xlsx, doc, docx, txt, jpg, jpeg, Max. file size: 50 MB. Optional: additional supporting material including marketing collateral, audiovisuals, etc. Drop files here or Select files Accepted file types: pdf, xls, xlsx, doc, docx, txt, jpg, jpeg, Max. file size: 50 MB. Please review your inputs for accuracy before proceeding to the next stage.NameThis field is for validation purposes and should be left unchanged.
