BC Application for a Community Gaming Grant 2012-2025 free printable template

Gaming. gov.bc.ca BEFORE YOU START Use this form to apply for a community gaming grant to support community programs. Review the Guidelines Applying for a Community Gaming Grant. Review the Community Gaming Grant Pre-Application Checklist. Print Form Clear Form Application for a Community Gaming Grant Gaming Policy and Enforcement Branch Licensing and Grants Division L G File for your organization Mail PO Box 9310 Stn Prov Govt Victoria BC V8W 9N1 Courier 3rd Floor 910 Government St. Victoria...BC V8W 1X3 Telephone 250 387-5311 Web www. Gaming. gov.bc.ca/grants/formsguidelines. htm. SECTION 6 CERTIFICATION My acceptance of this statement indicates that I confirm and acknowledge I am a bona fide member of the organization the applicant making this application and my position title or role within it is as indicated herein. I am authorized to complete and submit this application by and on behalf of the applicant. Gaming. gov.bc.ca If applying by mail use the latest version of this form....Items in Section 5 Additional Requirements Application Attachments are required to complete this application. Late or incomplete applications will generally be returned to the applicant without being processed. Do not fax or e-mail your application it will not be accepted. Confirm your application has been received by viewing application status NOTE Do not use this form to apply for a major capital project grant or PAC/DPAC grant. Branch gov.bc.ca Canada Post your organization s mailing...address will be used if we do not have a mailing address on file the physical address will be used SECTION 8 USING GAMING PROCEEDS FOR CAPITAL PROJECTS / ACQUISITIONS Capital projects include construction of new facilities renovation or maintenance of existing facilities and property development. See section 5. 3 of the Guidelines for Applying for a Community Gaming Grant. A project with a total cost of 20 000 or less that is essential to the delivery of your organization s approved programs is...considered a minor capital project. Include the project as one of the planned uses of grant funding described for the program in Section 4 of this application form please note this is not considered a separate program. Gaming. gov.bc.ca/grants/forms-guidelines. htm SECTION 1 ORGANIZATION INFORMATION PLEASE PRINT CLEARLY Organization name as it appears on the constitution and/or certificate of incorporation if applicable City Postal Code Organization physical address if different than above Unit...and/or Street B.C. society number if the organization is a registered society in B.C. On what date did your organization start operating approximate date Fiscal year end month and day General program/service s or purpose s of your organization e.g. food bank meal program youth sports programs etc. Sector this application is for grant funding for programs within which of the following sectors choose one only funding sector is based on purposes outlined in your organization s constitution Is...your organization a service club e.g. Lions Elks etc. Yes No Number of eligible voting members June 1 2012 Number of board members Date of last annual general meeting DD-Mon-YYYY Number of voting members attending the last annual general meeting Retain a copy of this application for your organization s records. Two board members of the organization officers who are responsible for the application both must sign this form 1 Position with the organization First name Address Unit and Street...Business phone number XXX XXX-XXXX Last name Ext E-mail address provide a valid e-mail address Province Home phone number XXX XXX-XXXX Cell phone number XXX XXX-XXXX Signature Date signed DD-Mon-YYYY X Submitter if the submitter is one of the people above include only their name below Contact Person if the contact person is one of the people above include only their name below SECTION 7 DELIVERY METHOD Results can be delivered to you by e-mail or by Canada Post or you can view them by signing...onto the Gaming Online Service with a BCeID username and password. For more information about BCeID contact the branch. Select your preferred delivery / notification method choose one only E-mail provide one valid e-mail address in the space at right for notification purpose multiple addresses not accepted NOTE Ensure that your e-mail is set up to allow messages that are sent from Gaming Policy and Enforcement Branch e-mail addresses gamingonlineservice gov.bc.ca and gaming.