Seeds of Hope
Granting Program

Grant Application Form

Please choose one:
   Spring Cycle_________(year)   Fall Cycle_________(year)

The United Church of Canada
L’Église Unie du Canada
and
The United Church of Canada Foundation

For assistance please visit the website: www.unitedchurchfoundation.ca/grantinformation
call 866-340-8223, or e-mail fdn@united-church.ca

Part One: Organization Details
Contact Information
Name of Organization:		
Primary Contact:		
Title: 		
Mailing Address:		
City / Prov. / Postal Code:		
Daytime Phone:		E-mail:		
Fax:		Website:		
Charitable Registration No.		
Have you received granting monies from The United Church/United Church Foundation before?	   Yes
   No
	Amount $

Year

Source	
Application Approval
This application has been approved by: (check all that apply) Please note: if your project requires Presbytery approval, please include related documentation with your application.	
Session	Board 	Council of Congregation 	Pastoral Charge	
Camp	School	Outreach Ministry	Other Ministry	
Name of Church or Ministry:		
Print Name of Signing Officer:		
Title of Signing Officer:		
Signature of Signing Officer:		
Date:		
Part Two: Project Overview
Funding Cycle:	   Spring
   Fall	Fund Applied to:		

Project Title:		

Is this a new project? (Preference is given to new projects)	      Yes       No	

Targeted Project Implementation Date:		
Targeted Completion Date: 		

Project Team Members
Name	Designated Role(s)	

		

Project Description (100 words maximum)

Project Uniqueness (Preference is given to innovative projects) (250 words maximum)

Project Goals and Objectives (250 words maximum)

Plan for Achieving Stated Goals and Objectives (250 words maximum)
	
Plan for Project Implementation and Delivery (250 words maximum)
	
Project Beneficiaries (100 words maximum)

Examples of Demonstrated Support (e.g. partners, letters of support, details of community involvement, etc.) (250 words maximum)

	

Recognition of Support Received from The United Church of Canada/The United Church of Canada Foundation if your application is successful (100 words maximum)

Volunteer Support
Recruited Volunteers	Estimated Number of Hours	

		

Part Three: Project Revenues and Expenses
Project Revenues
Project Revenues	Amount	Confirmed (Yes/No)	Anticipated Grant
Confirmation Date	
Organization Funds	$	     Y          N		
Other United Church of Canada Support 	$	     Y          N		
Other Grants 	$	     Y          N		
Other Fundraising 	$	     Y          N		
Funding from Partners	$	     Y          N		
Amount Requested from Seeds of Hope (must be no more than 50% of total revenue)	$		
Total Revenues	$		

Project Revenue Sources
Project Revenue Source (from above chart)	Project Revenue Contributor	
e.g. Other Grants	e.g. Community Foundation	

		

Project Expenses
Expense	Amount	
Project Staff	$	
Project Materials and Supplies	$	
Project Publicity	$	
Other	$	
Total Expenses	$	

Major Project Expenses

		

		

		

Focus for Applied Funding (250 words maximum) 

Proposed Plan Revisions if Funding Is Unavailable (250 words maximum)

Part Four: Project Evaluation
Anticipated Measurable Outcomes (250 words maximum)

Plan to Assess Measurable Outcomes (250 words maximum)

Timeframe for Achieving Anticipated Outcomes
Timeframe	Anticipated Outcome	

		

		

Part 5: Declaration of Intent
On behalf of the applicant(s), I declare that if awarded a grant by The United Church of Canada / The United Church of Canada Foundation Joint Grants Committee, the organization named on the Grant Application Form shall use the funds awarded solely and explicitly for the purposes stated and in accordance with the Statement of Expenditure (budget) as submitted and approved. 
Any portion of the grant funds not used for the purposes stated in the Grant Application Form or any portion not required to complete the project or meet the objectives as described, will be returned to The United Church of Canada Foundation, unless prior written permission to vary the stated purposes is obtained from the Joint Grants Committee.  
It is agreed that if the applicant is awarded funding, the organization will provide to the Foundation staff, within ninety (90) days of project completion, the following documentation:
•	a detailed report on the funded project as outlined on the Seeds of Hope Grant Follow-Up Report Guideline document.
•	one copy of all promotional pieces associated with the project including press releases, printed material and internet advertising
•	any other relevant information that may serve to assist in satisfying the United Church/Foundation requirements
The conditions stated above have been reviewed and agreed upon by signing authorities for the organization named on the Grant Application Form.

Print Name of Signing Officer:		
Title of Signing Officer:		
Signature of Signing Officer:		
Signed at:		Date: