Grant Application Form

Please fill in all the fields.

1. Contact Information

Full Legal Organization Name

Street Address

City

Province
---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland andLabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Postal Code

Organization Website

Registered Charities Number

Contact

Contact Person

Title

Phone Number

E-Mail Address

Alternate Contact

Alternate Contact Email

Project Title

2. Project Information

Project Description

Project Impacts

Project Timelines

3. Project Funding

Funding Requested from Our Lady of the Prairies Foundation ($)

Applicants Funding For Project ($)

Funding from Other Sources ($)

List of Funding from Other Sources (R = Requested, A = Approved)

TOTAL Project Funding ($)

Project Costs (List item/activity and cost associated)

I CERTIFY that all the information provided in this and any attached documents is true and correct. I ACKNOWLEDGE that meeting the eligibility criteria does not confer a right to financial assistance.

I agree with the above statement.

Name and Title of Approved Signee

Please include a copy of your most recent Audited Financial Statements as part of your application.

Please note that the attachment size is restricted to 5 MB.