"Volunteer Recognition Policy Application Form" - Northwest Territories, Canada

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Volunteer Recognition Policy
Application Form
Please refer to the funding policy for more details on funding criteria and eligibility.
Name of community government:
Address:
Community government contact information:
E-mail:
Contact person (please provide name and position in community government):
Alternate Contact person in community government:
E-mail:
Brief Description of Community Volunteer Recognition Event
Name of the event:
Date of the event:
Participants (indicate numbers, if the people are volunteers of your community government, what function
they have, and provide the names of the volunteer organizations if applicable):
Event design descriptions (agenda of event including ceremonies, awards, etc.)
P.O. Box 1320, Yellowknife NT X1A 2L9
www.gov.nt.ca
C. P. 1320, Yellowknife NT X1A 2L9
Volunteer Recognition Policy
Application Form
Please refer to the funding policy for more details on funding criteria and eligibility.
Name of community government:
Address:
Community government contact information:
E-mail:
Contact person (please provide name and position in community government):
Alternate Contact person in community government:
E-mail:
Brief Description of Community Volunteer Recognition Event
Name of the event:
Date of the event:
Participants (indicate numbers, if the people are volunteers of your community government, what function
they have, and provide the names of the volunteer organizations if applicable):
Event design descriptions (agenda of event including ceremonies, awards, etc.)
P.O. Box 1320, Yellowknife NT X1A 2L9
www.gov.nt.ca
C. P. 1320, Yellowknife NT X1A 2L9
Objectives of this event and how it will encourage and promote community volunteerism (by recognizing or
volunteers or volunteer organizations):
Location of event (name of location (venue), whether the location is rented or donated):
What results and benefits do you anticipate for your volunteers, volunteer organizations, and community
from hosting this event?
Funding needed to run the event: $ ____________________
Funding being requested through the Volunteer Recognition Policy: $ ____________________
BUDGET: Provide all revenues and expenses for this event
Volunteer Recognition Policy Contribution
(Materials and supplies, rental of
Revenue
Expenditures
Amount (maximum $1000.00):
venue(s), food/catering, etc.):
(Community contribution, fees, fundraising, etc.):
Other revenue for this event
Total Revenue:
Total Expenditures:
P.O. Box 1320, Yellowknife NT X1A 2L9
www.gov.nt.ca
C. P. 1320, Yellowknife NT X1A 2L9
MACA will send a notice of approval or rejection to the contact provided.
The financial contribution will be issued as reimbursement once the event is finished. The items for
reimbursement must be included in this application and comply with the Volunteer Recognition Policy. The
following documents must be received by MACA within 30 days of completion of the event or by April 30
,
th
whichever date occurs first:
1. a summary report detailing how the funding was utilized using the template provided by MACA;
2. a financial report showing all revenues and expenses, and;
3. original receipts (or scanned PDF copies are acceptable) for any eligible expenses that are claimed
for reimbursement.
SIGNATURES
Submitted by:
Date:
Print name and community government
Signature
Please submit this application to:
Youth and Volunteer Programs Officer
Municipal and Community Affairs
600 - 5201 50th Avenue
Yellowknife, NT X1A 3S9
Phone: (867) 767 9166 x21109 / Fax: (867) 920 6467
Email:
dawn_moses@gov.nt.ca
MACA Approval
For office use only
Print name
Title
Signature
Date
________________________
________________________________
______________________________
________________
MACA comments:
P.O. Box 1320, Yellowknife NT X1A 2L9
www.gov.nt.ca
C. P. 1320, Yellowknife NT X1A 2L9
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