DATE:

A: Organization Information:

Name of organization:

BC society number or registered charitable tax number:

Is your organization part of a larger provincial organization? Yes No

If yes, describe:

Contact person: Title:

Mailing address: Postal code:

Phone: Fax: E-mail:

Organization’s mandate and/or goals/objectives:

Has your organization received funding through Columbia Power before ? Yes No

If yes, when?

B. Project Information

Name of project:

Project start date: Project end date:

Brief project description:

Community Sponsorship Funding Application

1 Community Sponsorship Funding Application Form 11/2014For help with this application call 250.304.6047

+Positive Community Partnerships

B: Continued Project Information:

Benefits of the project (social/economic/other):

Community to be served by project:

C: Project Budget:

Requested grant amount from Columbia Power $ How will the funds be used?

Other financial contributors to the project:

Secured (including amounts): Pending (including amounts):

D: Sponsorship Recognition:

How will Columbia Power be acknowledged?

Other Information (please use the space provided below or the back of this application form to provide any additional information you feel should be included):

Community Sponsorship Funding Application

2 Community Sponsorship Funding Application Form 11/2014For help with this application call 250.304.6047

Applicant Agreement:

I agree to comply with the following requirements:

• Any funds awarded will be used solely for the purpose for which the grant was approved, unless written permission isobtained from Columbia Power to vary this purpose.

• Any funds not used will be returned to Columbia Power.• I agree that the documents requested in the Application Requirements form part of this application.• I agree that Columbia Power will be acknowledged for their contribution as described in Section D of this application.• I confirm that this organization has a current registered federal charitable tax number of a BC Society registration

number.• I agree that my organization will submit a final brief report outlining the activities and success of the Project as well

as documentation supporting the expenditures that have been incurred within 60 days following the completion of theProject.

Checklist:

I have attached a project budget YES NO and most recent financial statement YES NO

I have attached all applicable additional information, brochures or promotional materials to this application (if any exist)

YES NO N/A

Signature of authorized representative:

Name (please print): Title:

Date:

Please note: There is no deadline for submissions to the Community Sponsorship Funding Program but applicants are encouraged to submit an application well in advance of their project start date. Please allow six to eight weeks from the date of receipt of the completed application to notification of the outcome of the Sponsorship Funding Program application form.

Completed applications can be mailed, faxed, e-mailed or dropped off at Columbia Power’s office attention:

Kathleen HartCommunity Sponsorship Program Manager

Suite 200, 445 - 13th AvenueCastlegar, BC V1N 1G1Fax: 250.304.6083Email: kathleen.hart@columbiapower.org

Community Sponsorship Funding Application

3 Community Sponsorship Funding Application Form 11/2014For help with this application call 250.304.6047

For office use only

Project Number: Amount Awarded: