Whanau Ora Funding Application

Whanau Ora Funding Application
Organization Name
Contact Name
First NameLast Name
Job Position/Title
Phone Number
Area CodePhone Number
Email Address
example@example.com
Office Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Organization Goals and Objectives for year 2020

Project Name/Title
Project Description
Reasons why the organization needs funding:
Where are you normally getting your funding for your organization?
What is the focus of your funding? Please explain it below:
What is the long-term goals of your organization?
Where will the funding be mainly used?
Financial Budget ($) vs Requested Fund ($)
Rows Financial Budget ($) Requested Fund ($)
Facilitation and Preparation
Consultation
Development and Completion
Total Requested Fund ($)
Reminder: Funding cannot be used for payment of existing debts, overseas travel, activities that are only beneficial for a single person, salaries, or rents.

By signing below, you acknowledge that this form will collect the information about your organization and used it as a basis for approval. The information will be used for statistical purposes. The applicant (representative/organization) will take accountability for all essential docunent related to this project.
Whanau Representative Name
First NameLast Name
Whānau Representative Signature
Clear
Date Signed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Authorized Person Name
First NameLast Name
Authorized Person Signature
Clear
Date Signed
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Rows	Financial Budget ($)	Requested Fund ($)
Facilitation and Preparation
Consultation
Development and Completion