Contact Details

Name of Organisation

Contact Person

Postal Address

PO Box Address

Telephone

Email

Contact 1 Name

Contact 1 Phone

Contact 2 Name

Contact 2 Phone

Club Details

Are you a school or club?

How many participants aged between 5 - 18 will this travel subsidy benefit?

How many participants are aged between 5 - 11 years?

How many participants are aged between 12 -18 years?

How many members belong to your club/organisation?

Please detail how many applicants are female

Please detail how many applicants are male

Does your application involve a partnership with a local school? (If yes, please provide the schools name)

What is this funding going to be used for? (Briefly explain)

Application Details

Do you have any disabled individuals who are being supported by this fund? If yes, how many will receive support from the RTF

What percentage of your members live in the vicinity of the local authority you are applying to for the rural travel fund?

Are you registered for GST?

If yes, please provide GST number

How much money are you applying for? (This includes, Sport NZ funding, Other funders and your contribution)

Have you applied to any other organisation for funding and if so what was the result (briefly explain)

Do you have endorsement of your local affiliated club/school for this application for funding? (this is only relevant if the group applying is the regional body). If yes briefly explain and attach evidence of this)

Total distance travelled (km)

Total number of trips

Total number of vehicles used

Council Consent and Supporting Documents

We consent to Tararua District Council authority collecting the personal contact details and information provided in this application, retaining and using these details and disclosing them to Sport NZ for the purpose of review of the rural travel fund. This consent is given in accordance with the Privacy Act 1993

A balance sheet from your organisation (i.e. financial statement)

A deposit slip (in case your application is approved)

Evidence of your endorsement from your local affiliated club/school (if required)