Faith-based and Cultural Facilities Relaunch Grant ... · Web viewAuthor Ministry of Culture, Multiculturalism and Status of Women Created Date 02/05/2021 15:24:00 Title Faith-based

Faith-based and Cultural Facilities Relaunch Grant Application Form

The information indicated on this form is confidential and will be used for the purpose of depositing your payment directly into your bank account. We will not release this information for any other purpose. If you have any questions or concerns, please follow up with your Ministry Contact.

Faith-based and Cultural Facility Relaunch Grant

Application Form

Submit application by:

· Email : [email protected]

~IMPORTANT INFORMATION~

Intake submission deadlines:

· December 15, 2020

· March 1, 2021

*Applications must be complete upon submission. No additional documentation

will be accepted after intake submission date.

Before applying, please read the Faith-based and Cultural Facility Relaunch Grant Fact Sheetand the Program Overview available on the webpage.

NOTE:Click for Expense Claim Form

Visit Last Page for Application for Direct Deposit

Contact: 1-800-642-3855 for application questions.

Please keep a copy of this application for your records.

2020

Application Checklist – Read through carefully and ensure all boxes are checked

NOTE: Incomplete applications may be cancelled or delayed in processing

To make sure your application is processed as quickly as possible, please check, complete, and attach the following items before you submit:

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You have reviewed the Fact Sheet and Program Overview document for criteria and eligibility.

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Your organization is in good standing under the incorporation body, Alberta Corporate Registries. If you are unsure, please contact them at (toll-free by first dialing 310-0000) 780-427-7013.

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All accounting and reporting requirements for any previous Government of Alberta funding has been

completed. Organizations with outstanding Alberta Culture, Multiculturalism and Status of Women

reporting will not be considered for new funding until their outstanding accounting and reporting

requirements have been satisfied.

Mandatory Documentation:

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A complete application form.

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A current list of board members and must include: names, positions/titles, daytime phone numbers, and email addresses.

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Most recent Financial Statements (audited or unaudited) or Council Resolution signed by two authorized representatives of the organization.

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If the type of facility ownership your organization is:

Type of Facility Ownership:

Include the Following Required Documentation

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Owner and Operator

Certificate of land title in the legal name of the applicant

Note: If the certificate of land title is not in your organization’s name you need to secure from the titleholder a user agreement, memorandum of understanding, or support letter. The letter must state if the term of your operation is indefinite of there is an end date.

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Operator with a Valid Lease/Rental Agreement

Valid lease/rental agreement in applicants name

Note: Lease/rental agreement must demonstrate an existing landlord-tenant agreement for a minimum of two years.

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Other:

User Agreement, Memorandum of Understanding, Support letter from facility titleholder

Note: The letter must state if the term of your operation is indefinite or if there is an end date.

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Complete and attach the Excel Expense Claim Form for Section B. (NOTE: if you have multiple facilities you are required to fill out one Expense Claim Form per facility).

Mandatory Documentation (Continued):

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Invoices or payment verification for the organization’s relaunch costs eligible for this grant (see Fact Sheet and Program Overview document for list of eligible expenses).

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For eligible expenses purchased by members and are not in the organization’s name submit the following documentation:

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Original invoice or receipt

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Invoice from the member to the organization

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Proof of reimbursement to the member

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Complete and attach the Application for Direct Deposit form for Electronic Funds Transfer (EFT) and a VOID cheque.

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Grant Agreement Section 1 and 2 of the application, reviewed and signed by an authorized signing authority for the organization.


Application Submission Date: Click or tap to enter a date.

For Office Use Only

Section A – Organization Overview

Incorporated (Legal) Name of Organization (must match incorporation name):

Verified Name

☐

Yes

☐

No

Act the Organization is registered under:

Verified Registration

------ Select An Act ------

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Yes

☐

No

Registration Number:

Registration Date: Click or tap to enter a date.

Address of Organization:

Verified Address

☐

Yes

☐

No

City:

Province:

Postal Code:

Mailing Address (for Organizations registered outside of Alberta, the address must be Alberta based and regularly monitored by an active member of the Organization)

Verified Mailing Address

☐

Yes

☐

No

City:

Province:

Postal Code:

Organization Contact Information:

Legal Authorized Signing Authority Contact (must be an Alberta representative’s contact details)

Contact signed the grant agreement

Name:

Click or tap here to enter text.

Organization Position Title:


☐

Yes

☐

No

Daytime Phone:


Extension: Click or tap here to enter text.

Email:


Primary Application Contact (must be an Alberta representative’s contact details):

Contact signed the grant agreement

Name:


Organization Position Title:


☐

Yes

☐

No

Daytime Phone:


Extension: Click or tap here to enter text.

Email:


** Note: Should either of these contacts change, it is your responsibility to contact Community Grants office at 1-800-642-3855 to provide the current contact information.

7

Classification: Public

Section A – Organization Overview (continued)

For Office Use Only

Places of worship and cultural organizations whose mandate includes a religious, spiritual, or ceremonial component that plays a vital role in providing holistic cultural experiences, programming and education for Albertans.

Please provide your organizations mandate:

Information Provided

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Yes

☐

No

Your organization’s primary mandate:


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Cultural

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Religious

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Spiritual

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Ceremonial

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Other:

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Yes

☐

No

What is your organization’s annual operating budget?


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Under $50,000

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$100,000 - $500,000

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$1 million - $2 million

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$50,001 - $100,000

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$500,000 - $1 million

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Greater than $2 million

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Yes

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No

How many employees does your organization employ?


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0 employees

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101 – 200 employees

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500 + employees

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1 – 50 employees

☐


☐


☐


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Yes

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No

Number of volunteers:


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0 volunteers

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101 – 200 volunteers

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500 + volunteers

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1 – 50 volunteers

☐


☐


☐


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Yes

☐

No

How many members do you serve?


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Up to 50 members

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101 - 200 members

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301 – 500 members

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51 – 100 members

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201 – 300 members

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500 + members

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Yes

☐

No

How many facilities does your organization operate?


Number of facilities:

Number of facilities you are applying for reimbursement?

Note: Please submit a separate Expense Claim Form for each facility indicating Facility name and Address (at the top of the worksheet) and complete the questions regarding the facility.

☐

Yes

☐

No

Section B – Expense Claim Form

For Office Use Only

Organization must submit a separate Expense Claim Form for each facility that is being reimbursed. Please ensure the following is complete and provided:


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Complete Expense Claim Form for each facility that you are applying for reimbursement.

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Invoices/Receipts for each expenses listed in the Expense Claim Form.

· Invoices must be in the name of the organization and clearly identify the corresponding facility.

· Expenses must have been incurred between April 1, 2020 – March 1, 2021.

☐

Provided required documentation for the following, if you are a:

· Owner and Operator – Certificate of land title in the applicants name.

· Operator – Valid lease/rental agreement in the applicant’s name (must be valid for a minimum of two (2) years at the time of application.

· Other – Provide a support letter from the facility titleholder confirming the applicant may operate and use facility.

☐

Yes

☐

No

Section C – Financial Information

For Office Use Only

1. Has your organization experienced a loss in revenues and/or donations since March 2020?


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Yes

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No

What was the percentage of lost revenues and/or donations since March 2020?

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Yes

☐

No

2. What programs and services are you currently offering?


What program and services were you offered before COVID-19?

What programs and services are you currently offering?

Does your organization’s facility (facilities) serve another purpose in your community? (example: emergency centre, voting poll)

☐

Yes

☐

No

3. How many gatherings/ceremonies/events are scheduled for the next month to six months?


Please provide the number of events?

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Yes

☐

No

4. What health directives did you implement that align with the Guidance for Places of Worship and the Alberta Health Services directives for events and gatherings located at the facility?


Based on the health directives which of the following has your organization been able to meet:

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Implement practices to minimize the risk of transmission of infection among attendees

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Provide procedures for rapid response if an attendee develops symptoms of illness

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Ensure that attendees maintain high levels of sanitation and personal hygiene

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Meets Alberta Health Services directives for maximum capacity for indoor gatherings. Reference Guidance for Places of Worship

During Alberta’s relaunch, it is expected that operators will make modifications to their services and settings to reduce the risk of transmission of COVID-19 as identified in the Guidance for Places of Worship document and the Alberta Health Services directives.

☐

Yes

☐

No

Section D – Electronic Funds Transfer (EFT)

For Office Use Only

Please ensure that both documents are complete and attached.

☐

Application for Direct Deposit (See last page of application form). Form must list the incorporated legal name of your organization as incorporated, signed by legal signing authority and stamped by financial institution.

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Copy of a VOID cheque with the incorporated legal name of your organization and account number matching that of the Direct Deposit.


☐

Yes

☐

No


Grant Agreement Section 1 of 2

Incorporated (Legal) Name of Organization (“Organization”):

The Organization declares that:

a) The information contained in this application and supporting documents (“Application”) is true and accurate and endorsed by the Organization.

b) The required expense claim information for the expenses incurred are true copies and have been attached to and form part of the Application.

The Organization understands and agrees that should this Application be approved, any grant funding awarded is subject to the Organization complying with the terms and conditions of this Agreement.

The Organization agrees to the following terms and conditions:

1. The Faith-based and Cultural Facility Relaunch Grant Fact Sheet and Program Overview (“Guidelines”), clauses 10, 11, and 12 of the CIP Project-Based guidelines (“CIP Guidelines”), and the Application form part of this Agreement and the Organization agrees to be bound by the requirements set out in them.

2. The Organization must comply with all applicable laws. The Organization agrees that it is and will be bound by the provisions of the Community Development Grants Regulation, and acknowledges that this includes, but is not limited to, the provisions in section 8 setting out the Organization’s obligations to repay the grant under the circumstances described therein.

3. The Organization acknowledges that the Freedom of Information and Protection of Privacy (“FOIP Act”) applies to records submitted by the Organization to the ministry in relation to the grant application, including the Application and this Agreement. These records may be disclosed in response to an access to information request under the FOIP Act, subject to any applicable exceptions to disclosure under the Act.

4. The Organization agrees that any information relating to the Grant and the Organization’s compliance with the obligations set out in this Agreement may be disclosed to other ministries within the Government of Alberta.

5. The Organization agrees to indemnify and hold harmless the Government of Alberta, including the Minister, Government of Alberta employees, and agents from any and all claims, demands, actions, and costs (including legal costs on a solicitor-client basis) for which the Organization is legally responsible, including those arising out of negligence or willful acts by the Organization or its employees or agents. Such indemnification shall survive the termination of this Agreement.

6. This Agreement shall be governed and interpreted in accordance with the laws enforced in the Province of Alberta.

7. This Agreement is not intended to and does not make either part the agent or partner of the other for any purpose or create a joint venture.

8. This Agreement may not be assigned by the Organization.

9. The Organization will recognize the source of the Grant as required by the CIP Guidelines.

10. The Organization represents and warrants that the person signing is duly authorized to make the Application and is legally sufficient to bind the Organization to this Agreement.


Grant Agreement Section 2 of 2

*All boxes must be checked to proceed*

I hereby acknowledge that:

☐ The information contained in this application and the accompanying documents is true, accurate, and complete.

☐ I am a representative with designated signing authority/decision-making authority in our Organization.

☐ The Organization’s Board of Directors is in full support of this application.

☐ I have read the Conflict of Interest section in the Community Initiatives Program Project-Based Guidelines (clauses 11.1 through 11.4) and I am not aware of any conflict of interest either perceived or apparent in applying for the Faith-based and Cultural Facility Relaunch Grant.

☐ I have read the Faith-based and Cultural Facility Relaunch Grant Agreement Section 1 of 2 which outlines the terms and conditions of the grant agreement and by signing Section 2 of 2, I am agreeing to all of the terms and conditions outlined in Section 1 of 2.

☐ I am aware that as a requirement of the grant, the organization will complete a survey regarding the program and grant process if community grants deems necessary.

Click or tap to enter a date.

Click or tap here to enter text. Ext. Click or tap here to enter text.

Signature of Authorized Representative

Date

Daytime Phone




Authorized Representative Name (printed)

Organization Position Title

Email

The personal information that is provided on this application form will be used for the purposes of administering the applicable grant program and advising the applicant of Community Grant program updates and relevant ministry initiatives and resources. It is collected under the authority of section 33(c) of the FOIP Act and is protected by the privacy provisions of the FOIP Act. The FOIP Act applies to any information that is provided to Alberta Culture, Multiculturalism, and Status of Women. This information may be disclosed in response to an access request under the FOIP Act, subject to any applicable exceptions to disclosure under the FOIP Act.

Opt Out:

☐ I do not agree to allow Alberta Culture, Multiculturalism and Status of Women, on occasion, to contact the applicant as identified on this application form to provide information about ministry initiatives or announcements related to the following topics:

· Grant program changes, funding announcements, and opportunities to provide input/opinion on programs; and

· Awareness of ministry resources available to the nonprofit sector, including ministry sector events.

Completion of All Fields is Mandatory. Incomplete forms will not be processed.

INSTRUCTIONS

· Culture, Multiculturalism & Status of Women require you submit both an original personalized void cheque and an original completed and signed direct deposit form. Any alterations to the information that is preprinted on a cheque will not be accepted.

· Funds will only be deposited into ONE bank account.

· Funds can only be deposited in the name of the person or company who CURRENTLY receives the cheque from the Ministry.

· This form must be signed by both spouses where both spouses are registered as the payment recipients.

· This form must be signed by an official representative of the Bank and must contain the “Bank Teller Stamp.”

· Please return the signed form to your Ministry Contact for processing.

Part 1

Partly Authorized to Receive Payment

See sample cheque below to complete the following information

Vendor Number (if known)

Last Name (Individual) Trade Name & Legally Incorporated Name (Company)

First Name (Individuals)

Middle Name

Address

City/Town

Province

Postal Code

Telephone Number (include area code)

Email address is required for electronic delivery of remittance advice:

I authorize the Province of Alberta to make all payments due to me by electronic deposit to the below account. Payment shall continue until I advise otherwise,

Dated

Signed

Dated

Signed

Part 2

Bank Information

B. Name of Bank

C. Bank Address

Type of Account (please check one):

D. Bank Transit/Branch Number

E. Bank Number

F. Account Number

☐

Chequing

☐

Savings

Print Name of Financial Institution Officer

Telephone Number

Dated

Financial Institution Officer’s Signature

Classification: Public

Documents

Faith-based and Cultural Facilities Relaunch Grant ... · Web viewAuthor Ministry of Culture, Multiculturalism and Status of Women Created Date 02/05/2021 15:24:00 Title Faith-based