Language
English (UK)
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?
*
Incorporated Society
Charitable Trust
Social Enterprise
Regional or Local Council
For-profit Organisation
Primary/intermediate School / Kura
Secondary School / Wharekura
Tertiary Education / Wānanga
Marae, Hapū, Iwi, Māori
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)
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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?)
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Up to 220 Words
Where will it occur?
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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?
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Play
Active Recreation
Sport
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
Kaupapa Maaori Questions
Te Whetu Rehua Framework
https://sportnz.org.nz/kaupapa-maori/e-tu-maori/te-whetu-rehua/ You selected that your project or programme is provided in a kaupapa Maaori context. This means that your application will be assessed against Te Whetu Rehua Framework. Please answer the below questions as part of your application.
Leadership/delivery: Is the project being delivered by Whaanau, Hapu, Iwi or recognized Maaori leaders?
Language: Full immersion or bi-lingual?
Participants: Is it for Maaori groups & their whaanau?
Venues: Is the programme at Marae or places of Maaori significance?
Activities: Are there traditional activities included in the programme i.e. Ki o Rahi, Waka, Poi?
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.
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Start Date - End Date
Is this a new, existing or modified/expanded project or programme?
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New
Existing
Modified/expanded
School support explanation
What setting/s will your project take place in?
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Community Setting(s)
Primary/Intermiate Schools/Kura
Secondary Schools/Wharekura
Tertiary Education/Wānanga
Marae
Home Setting
Other - please specify
If any part of your project is to be delivered in schools/kura please advise when.
*
Not in schools
In class time
Out of class time
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)
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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
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Conditions of Application
*
Yes
No
I confirm that I am authorised to submit this application on behalf of the organisation, and that our directors and/or trustees and/or treasurer are aware of and support this submission.
I have read the “Tū Manawa Active Aotearoa Community Guidelines 2020-2021”.
I will comply with the requirements set out in the “Protecting your information” section of the Tū Manawa Active Aotearoa Community Guidelines 2020-2021” and have advised my organisations’ Directors, Trustees and/or committee members of the information in that section
I confirm that information in this application is correct, and that any amount we receive as a result of this application will be used solely for the purposes specified in this application.
I acknowledge that Sport NZ/RST has the right to audit the information provided in this application and the use of any funds granted. I will provide full cooperation in the event of such an audit being undertaken.
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