Funding application request APPLICANT INFORMATION Please fill in all fields. CONTACT INFORMATION BUSINESS DETAILS Registered CharityNon-profitIncorporatedPartnershipSole ProprietorOther BACKGROUND PROJECT DETAILS APPLICANT CERTIFICATION AND ACCEPTANCE I certify that the statements herein are true, complete and accurate to the best of my knowledge and I accept the obligation to provide a follow up report if this application for funds is approved. The requirements of the follow up report and any other terms and conditions, to be complied with, will be provided to successful applicants. Use your mouse or your finger (on touchscreens) to sign your name. Applicant Signature Date: You’ll receive a copy of your application by email.