Application worksheet
A printable version of Palmerston North City Council - Green Shoots 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
Assessment Form SPG 25-28
Palmerston North City Council - Green Shoots 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://www.pncc.govt.nz/Community/Community-funding/Green-Shoots-Fund-–-helping-you-build-a-greener-future.
1. Assessor declaration
Conflict of Interest*
All assessors must declare if they have, or could be perceived to have, a conflict of interest. If an assessor has something to personally gain from an application being either successful or unsuccessful, or if members of the public could have grounds to perceive that the assessor could personally gain from a decision, do not proceed to assess this application.
Confidentiality*
I pledge to preserve the confidentiality of any information supplied to me in my role as an assessor for Palmerston North City Council. I will not make copies of or disclose this information unless explicitly authorised by Palmerston North City Council or required to do so by law. I will not use any information supplied to me in my role as an assessor for any personal gain.
2. Application assessment
Viability score*
Indicators: The applicant has the capability, capacity and experience to deliver the work; The applicant has a relevant track record of successful delivery; The applicant has the necessary experience, networks or profile to give them credible access to the people who will benefit; The applicant has a sound history (if any) of compliance with Council obligations; The application budget is realistic and evidenced-based; Funding would help the applicant to become stronger or more sustainable in the future; The applicant is in a strong financial position
Comments on 'Viability'
Your comments can be in bullet points. Please provide short and concise rationale for your recommendation.
Outcomes score*
Indicators: The applicant understands the difference they are trying to make in the community; The applicant has clearly defined the expected outcomes of their work; The expected outcomes are important to the Palmerston North community; The project, activity or service described is likely to achieve the expected outcomes; The applicant has given thought to how they will show the grant will benefit the community; The applicant has demonstrated how they will evaluate the success of the work
Comments on 'Outcomes'
Your comments can be in bullet points. Please provide short and concise rationale for your recommendation.
Alignment score*
Indicators: The expected outcomes clearly align with the Council's goals and contribute to achieving Council's outcomes for the community; This applicant provides evidence of collaboration with other organisations.
In your opinion, which outcome(s) does this application most contribute to?
Comments on 'Alignment with funding outcomes'
Your comments can be in bullet points. Please provide short and concise rationale for your recommendation.
Total score
This number/amount is calculated.
Do you recommend we fund this applicant?*
Final Comments
Your comments can be in bullet points. Please provide short and concise rationale for your recommendation.
How long did you take to complete this assessment?
Declarations
- I pledge to preserve the confidentiality of any information supplied to me in my role as an assessor for Palmerston North City Council. I will not make copies of or disclose this information unless explicitly authorised by Palmerston North City Council or required to do so by law. I will not use any information supplied to me in my role as an assessor for any personal gain.
Signature
Date
Worksheet generated by All Too Human (alltoohuman.nz/grants). Source: official PDF. This is not an official submission form.