2. First Name
3. Last Name
4. Date
6. Street Number
7. Apt #
8. Street Name
10. City
11. Province
12. Postal Code
14. Phone Number
15. Fax
16. Email
18. Alternate Contact
19. Alternate Contact Number
23. Organization
24. Date of Incorporation
25. Date of Registration
27. Society Act Registration Number
28. Revenue Canada Charitable Registration Number
30. Board of Directors
34. Geographic Area Served by Organization
35. Members in Good Standing
36. Highland Members
38. # of Full-Time Staff
39. # of Part-Time Staff
40. # of Volunteers
41. # of Volunteer Hours
43. # of Clients Served Last Year
44. # of Clients Served this Year (Projected)
45. # of Highland Residents
46. # of Highland Youth Residents
48. Current Budget
49. Income
50. Expenses
51. Requested Grant
53. Provide a brief history of your organization
55. Objective / mission statement of your organization
57. Services and/ or facilities your organization has provided in the District
59. What is the intended use of the funds
61. List of organizations contacted and amount of requested funds
63. Describe your project or special event date, its objective and its budget
65. Has your organization applied for a grant from the District previously

    1. YES
    2. NO
66. If yes please provide details
    Project | Year | Funding Received
68. Provide a brief summary of the benefits of your project which are directly or indirectly going to affect our District residents
70. Details relative to recent efforts your organization has made to make it self-supporting
72. Does your organization wish to make a presentation to Council

    1. YES
    2. NO

    If yes - provide contact information
74. Attach Documentation
    Only attach information that cannot be included in this form - such as financial statements. Thank you.
78. Electronic Signature
79. Title / Position
80. Date
82. Do you agree?*

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field