Application worksheet
A printable version of Invercargill City Council - Community Wellbeing Fund's application questions, extracted from their official form. Use it to plan your answers - then submit through the funder's real form.
View the original PDF →Application worksheet
Community Wellbeing Fund Accountability Report Form
Invercargill City Council - Community Wellbeing Fund
This worksheet mirrors the questions on the funder's official application form. It is NOT the official form. Submit your final answers through https://icc.govt.nz/community/community-funding/community-wellbeing-fund.
To be completed within 2 months of the end date of the activity.
1. Part 1 – Applicant Details
Full Name of Organisation:*
Mailing Address:*
Contact Person:*
Position:*
Phone:*
Email:*
Alternative Contact:*
Position:*
Phone:*
Email:*
2. Part 2 – Details of the Activity
2.1 Activity Name:*
2.2 Date/s this activity was held:*
2.3 Venue or facility where the activity took place:*
2.4 How many people took part in the activity? Participant Audience*
2.5 Funding amount REQUESTED from the Community Wellbeing Fund (from application):*
2.6 Funding amount APPROVED from the Community Wellbeing Fund:*
2.7 Total estimated cost for this activity (from application):*
2.7 Actual cost of the activity:*
3. Part 3 – Financial Report
3.1 What was the approved fund used for?*
Please attach invoices and/or receipts for these items.
3.2 Activity costs (Include costs from the estimated budget in your original application)*
3.3 Activity income (Include costs from the estimated budget in your original application)*
4. Part 4 – Outcomes
Overview of how the activity went and how it did or did not achieve the purpose of your original application. This could include:*
The community benefits achieved and the outcomes of the activity:*
5. Part 5 – Evidence
The committee would appreciate seeing evidence of the activity including but not limited to:
Newspaper clippings, Web or social media articles and/or reviews, Evaluation or survey results, Photos of the activity. By sending us these photographs, you agree for them to be used for future promotions of the fund.
Documents to attach
- invoices and/or receipts
- bank account statement
- profit and loss statement
- evidence of the activity
Worksheet generated by All Too Human (alltoohuman.nz/grants). Source: official PDF. This is not an official submission form.