Tū Manawa Application Form

Tū Manawa Active Aotearoa Application Form

A Sport NZ fund administered by Sport Waikato.
Tū Manawa Active Aotearoa Fund Overview
Organisation Name *
Organisation Website or Social Media Account (URL)
Tell us about the purpose of your organisation and what you do. *

Up to 150 words 0/150
Organisations Physical/Registered Address *

Street Address

Street Address Line 2

City Suburb/Region

Area Code
What type of organisation are you? *
If Relevant, what is your Incorporated Society Number, or New Zealand Business Number (NZBN)
www.nzbn.govt.nz
Is you organisation registered for GST? *

Yes No
What is your GST number? *
123-456-789
Organisation's Bank account name *
Organisations Bank Account Number *
00-0000-0000000-000
Attach photographic evidence of your organisation's bank account number and name *
Your Name *

First Name Last Name
Email *
example@example.com
Phone Number *
Role in Organisation *
(e.g. Chairperson, Treasurer, CEO)

Project/Programme Details
Project Summary explanation
Name of Project/Programme *
What is the Project/programme? (Please explain what it is, why it is needed, how it will be delivered & to how many participants. What kind of activities will be included?) *
Up to 220 Words
Where will it occur? *
Based on where your project will occur, please estimate the percentage of tamariki and rangatahi you will target from high deprivation areas *
Who will you be working with (participants)? *
What type of Physical activity does your programme involve? *
Please select the predominant activity type.
Kaupapa Māori explanation
Is this application being submitted for a project or programme that is provided in a kaupapa Maori context? *

Yes No

More project information
What are the proposed dates of your programme? Must be a maximum of 12 months. Please consider that if you are successful it may take up to a month to put an agreement in place. *
Start Date - End Date
Is this a new, existing or modified/expanded project or programme? *
School support explanation
What setting/s will your project take place in? *
If any part of your project is to be delivered in schools/kura please advise when. *
Please provide checklist for this in-class application. (Please ensure questions in checklist are answered by the school before submitting) *

Browse Files
Template can be found here: https://bit.ly/2GlSqyD Cancel of
Identify who your project aims to positively impact on? *

Tamariki (Children aged 5-11) Rangatahi (Young People, aged 12-18) Young Women (19-24) Disabled children or young people
Outcomes explanation
How do you know this project is needed from a 'participant' point of view? (Is this something tamariki & rangatahi want to be doing? How do you know?) *

Up to 150 words 0/150
What are the key positive changes (outcomes) your project is trying to bring about in the participants that you are working with? (Why are you doing this project & what do you hope participants will get out of it? Name up to 3 outcomes) *

Up to 150 words 0/150
Measurement explanation
Taking the outcomes above, how will you know you have achieved them? What will you measure and how? (What will success look like and how will you measure it?) *

Up to 250 words 0/250
Who will you be working with to deliver this programme? Include the organisations’names.

Up to 100 words 0/100
Confirm you comply with regulations that are relevant to your sector *

Browse Files
Select up to 3 relevant documents Cancel of
Is there any other information you would like to tell us? (re complying with regulation)

Project/Programme Costs

Please Provide your budget below - what are your costs? (Please itemise specifically as much as possible, ie. Wages, Petrol Vouchers, Bats, Balls, Kayaks) *

Cost Description

Amount ($)

Line Item 1

Line Item 2

Line Item 3

Line Item 4

Line Item 5

Line Item 6

Line Item 7

Line Item 8

Line Item 9

Line Item 10

Line Item 11

Line Item 12

Total Cost of project (this will self populate from the cost budget)

Please Provide your budget below - what is your income against this project/programme? *

Income Description

Amount ($)

Line Item 1

Line Item 2

Line Item 3

Line Item 4

Line Item 5

Total Income against this project/programme (this will self populate from the income budget)
What amount are you applying for from Tū Manawa Active Aotearoa? *
If there is a difference in the total cost and the amount you are requesting, how do you intend to fund the outstanding amount? *

If this does not apply please enter N/A 0/100

Tū Manawa Active Aotearoa Application Form

Project/Programme Details

Te Whetu Rehua Framework

Project/Programme Costs