"Historical Societies Assistance Program Application" - New Brunswick, Canada

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Download "Historical Societies Assistance Program Application" - New Brunswick, Canada

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Tourism, Heritage and Culture
Heritage Branch
H
S
A
P
ISTORICAL
OCIETIES
SSISTANCE
ROGRAM
Registered Name of Organization
Date of Incorporation and Number
Charitable Tax Number
Address (Organization)
City or Town
Postal Code
Telephone (Org.)
(506)
-
Fax (Org.)
(506)
-
E-mail (Org.)
Contact Name
Telephone (Home)
(506)
-
(506)
-
E-mail (Home)
Telephone (Work)
$
$
Previous year funding
Amount Requested
A
: A
15
PPLICATION DEADLINE
PRIL
Date received :
Funding level :
Approved 
Not approved 
Recommandation :
Reasons :
Manager :
Date :
Director :
Date :
Applications and all required supporting material must be sent electronically to:
museum@gnb.ca
Please note that government’s email system has a limit of 9-10 MB for any attachments.
Multiple emails to provide all the supporting material may be necessary.
Submit CD, DVD, flash drive to the mailing address at the end of the form.
1
Tourism, Heritage and Culture
Heritage Branch
H
S
A
P
ISTORICAL
OCIETIES
SSISTANCE
ROGRAM
Registered Name of Organization
Date of Incorporation and Number
Charitable Tax Number
Address (Organization)
City or Town
Postal Code
Telephone (Org.)
(506)
-
Fax (Org.)
(506)
-
E-mail (Org.)
Contact Name
Telephone (Home)
(506)
-
(506)
-
E-mail (Home)
Telephone (Work)
$
$
Previous year funding
Amount Requested
A
: A
15
PPLICATION DEADLINE
PRIL
Date received :
Funding level :
Approved 
Not approved 
Recommandation :
Reasons :
Manager :
Date :
Director :
Date :
Applications and all required supporting material must be sent electronically to:
museum@gnb.ca
Please note that government’s email system has a limit of 9-10 MB for any attachments.
Multiple emails to provide all the supporting material may be necessary.
Submit CD, DVD, flash drive to the mailing address at the end of the form.
1
1.0
Organizational Governance Information
1.1
Number of members in your organization
Membership fees (give
1.2
breakdown)
1.3
Number of volunteers
1.4
Number of hours given by volunteers for the past year
1.5
Number of paid staff ("Employment Programs" are under Tab 2.8)
(Please open the MS Excel Form. Select the appropriate tab and provide the
information required in appropriate columns.)
1.6
For each active committee within your organization, please provide an activity report.
1.7
Please attach and describe the current Board composition, including their function,
address and telephone numbers. Explain the approach for identifying new Board
member.
1.8
Please provide us with the following documents:
 An outline of the past year’s activities
 A copy of your most recent annual report
 President’s report
 Treasurer’s report
 Minutes of the annual general meeting
 Copy of your Strategic Plan (if applicable)
2.0
Information on activities offered by your organization
2.1
Describe and give programming details for the request year (actual and
planned). Include proposed operating dates, special activities and events.
Describe new initiatives you are hoping to accomplish.
N.B.
N.S. / P.E.I. / N.F.
2.2
Attendance at your institution during last year
Other
New England
Other US
Total
Ontario
Quebec
Canadian
CT/MA/ME
NJ/NY/PA
Foreign
Unknown
States
Provinces
NH/RI/VT
Number of school groups at your institution during the last year
2
2.3
When was your institution open to the public?
Specify the year:
All year long
Season
Hours/Day
Days/Week
Months/Year
Summer
Fall
Winter
Spring
Yes
2.4
Did you provide your services in both official languages?
Cultural activities
No
Yes
Brochure,
Yes
Yes
Yes
Information
Programming
Printings
No
Poster
No
No
No
2.5
Under your archival program, number of items in your collection
Number of items in your collection (if applicable)
Yes
2.6
Did you acquire any items for your collection during last year?
No
(Please attach a list)
Under your publication program, please list below details with respect to newsletters, journals, bulletins or
2.7
other forms of material your organization published last year. Please supply a copy of your publications
Number
Publication
Title
Author (s)
Print Run
List Price
of pages
Date
$
$
$
$
2.8
Participation in last year’s employment programs
(Please open the MS Excel Form. Select the appropriate tab and provide the information required in
appropriate columns.)
Professional development and member training during last year. List on professional
3.0
development opportunities provided to staff in the previous and current years.
Name of Individual
Training Course
Offered by
List all associations your organization is a member of.
4.0
(For example: Association Heritage New Brunswick, Canadian Museums Association,
Council of Archives New Brunswick, etc.)
3
5.0
Financial Information
Please consult the Financial Forms for Heritage Organizations for
additional details. Open the MS Excel Form. Select the appropriate tab and
provide the information required in appropriate columns.
6.0
Operational Effectiveness
Please indicate the actions taken by your organization in the last 12 months.
Number
Yes
No
Action
(if applicable)
Completed/reviewed a long-term strategic plan
Held a planning meeting for this year’s operation
Held an annual meeting. Members attending:
Voted in an annual budget
Voted in new board members
Held regular Board Meetings
Presented regular financial reports to the Board
Recruited new members/volunteers
Organized special events for members
Organized special events for the public
Please send us the documents identified below in the middle column and all other documents you
consider relevant for your organization. The information will be kept in our files for a period of 9 years.
In the meantime, if your organization makes changes to the documents you have submitted, we ask
that you provide us with the most recent updates as soon as they are passed by your board.
Our organization adheres to the following policies:
Previously
Revised version &
In preparation
Document
submitted
Attached
Rules and statutes
Strategic Plan
Dissemination Policy (exhibits, publications)
Educational Policy and Cultural activities
Acquisition Policy
Collections Management Policy
Professional development activities
Emergency procedures
Volunteer Policy
Communication Plan and Marketing Strategy
4
Our organization requires help or training with:
Strategic planning
Conservation
Policy development
Registration
Membership development
Public Programming
Board management
Fundraising
Other: _
_
A
:
GREEMENT AND ACKNOWLEDGEMENT
I hereby agree to provide all requested information as well as any other supporting documents
needed to evaluate this application. I understand that my application may be refused if it is
incomplete.
I recognize that applications are approved subject to availability of funds, and that beyond the
provision of a grant, the Government of New Brunswick has no further commitment to the
applicant. The Government will not be held responsible for the completion of an activity.
I agree to acknowledge the contribution of the Government of New Brunswick in all publicity
related to our activities.
I certify that this application and the budget included with the request have been approved by the
Board or by the Executive of the organization.
I certify that I have signing authority for the above-named organization, and that, to the best of my
knowledge, the information provided with this application is accurate. I agree to provide the
Department with a full report of the completed activities, including financial statements.
Name
Title
Signature
Date
The Department may revise program guidelines or suspend the program without notice if required funds are not
available. Meeting the eligibility criteria does not guarantee that a grant will be awarded. Because of the high
number of applications that may be received and the limited resources available, grants awarded may be smaller
than the amounts requested.
In the case of disagreement concerning the interpretation of its policies funding programs and their respective
components, the Department reserves the right to final interpretation of the intent and implementation of the
program.
The applicant hereby acknowledges and agrees that, if awarded a grant, the name of the grant recipient, the
recipient’s community, the program name, and the amount of the grant, will be published by the Department of
Tourism, Heritage and Culture on the Government of New Brunswick web site and in the Department’s Annual
Report.
Heritage Branch
Tourism, Heritage and Culture
Marysville Place
P.O. Box 6000, Fredericton, NB E3B 5H1
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