Application worksheet
A printable version of Waitaki District Council - Waitaki Heritage 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
Waitaki Heritage Fund Application
Waitaki District Council - Waitaki Heritage 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.waitaki.govt.nz/About-Waitaki/Living-here/Supporting-our-community/Community-Grants-and-Awards/Waitaki-Heritage-Fund.
1. Applicant Details
Applicant Name*
Place name and address for which funding is sought*
Are you the owner?*
If you are not the owner, what is your role in this project?
Brief description of project eg. earthquake strengthening, repairs, reroofing, condition report*
Application Date*
2. Contact Details for Applicant
Address*
Phone Number*
Email*
3. Heritage Protection Information
Is this listed with Heritage New Zealand?*
If yes, please provide list number AND
If no, please provide evidence of heritage significance
If listed with Heritage New Zealand, have they reviewed and supported the proposed works?*
If yes (Include letter of support if you have it)
4. Project Details
What is the place used for?*
How long do you expect the work to take?*
Professionals and tradespeople involved?*
Who has provided conservation advice?*
Has a conservation plan or a condition report been prepared for this place?*
If yes to above, is the work for which you are applying for funding identified in that plan?*
Will this use change as a result of this work?*
Are you GST registered?*
Total cost of project (excluding GST)*
Your contribution*
Have you sought other funding for this project? (Please provide details)
Shortfall*
How much are you applying for?*
If yes, GST Number (please enter one digit in each box)
5. Declaration
I hereby apply for a grant towards the cost of the works described above*
I/We are unable to meet the full cost but I/we would be prepared to make a maximum contribution from my/our own resources of
I/We enclose a copy of our audited annual accounts for the last financial year (in the case of an incorporated society).*
Documents to attach
- Plans and specifications (where relevant)
- Two quotes from tradespeople
- Photograph of the place for which funding is sought
- Evidence of heritage significance if unlisted
- A letter of support from Heritage New Zealand (if the place is listed with Heritage New Zealand)
- A bank deposit form for your bank account
Declarations
- I/We hereby declare that the information supplied in this application is correct.
- If the application is successful, I/we agree to provide an accountability report (which will be sent to me/us with my/our grant) stating that the funding received has been spent on the project as stated in this application.
- I/We also agree to participate in any funding audit of my/our organisation conducted by the Waitaki District Council.
Signature
Date
Worksheet generated by All Too Human (alltoohuman.nz/grants). Source: official PDF. This is not an official submission form.