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Fee for Service Grant Application

This application form is for Non-profit Organizations who are applying for a Fee for Service grant. The City of Fort St. John may contact you to request additional information, or clarification, to support your application. To ensure your application is considered, please complete and return the application with all required documentation by March 1 (unless otherwise specified).

Eligibility Criteria

Fee for Service grant funding is provided by the City of Fort St. John, under an agreement, to assist local non-profit organizations with the delivery of services to the community that would otherwise be delivered by the City as the service falls within the realm of municipal service. The Fee for Service grant represents the City’s contribution towards the group. The term Fee for Service does not imply that the City’s contribution is intended to be a 100% contribution.

Grant applications must be consistent with the aims, objectives, and standards of the City of Fort St. John, and must not be at variance with any City policies.

Submitted applications will be presented for Council approval. Organizations may be required to present to Council at a Committee of the Whole meeting.

Community Grants Council Policy No. 105 [PDF - 239 KB]

Section 1 - Organization Information

Organization Name:

CRA/Society Act/Charity Registration Number:

Contact Person:

Phone Number:

Address of Organization:

Mailing Address (if different than above): (optional)

Section 2 - Supporting Documentation

Ensure you upload all required supporting documentation and check off the attached documents in the list below.

Supporting Documents Checklist

Constitution, Bylaws and Society/Charity certification (if not previously provided or if changes have occurred)
Current list of board members
Number of employees, their titles, and number of hours paid per year (full time and part time)
Previous years’ meeting minutes and annual general meeting minutes, (including manager’s report, if applicable)
Detailed proposed budget for the current year, listing revenue/expenses and all other grants and donations
Audited financial statements for the previous fiscal year
Statement identifying the amount of reserved funds, if any, and the purpose of those funds
Identification of the name and position of any individuals who receive payment from the fee for service funds, (salaries, honorariums or contracts) together with the amount of compensation each receives

Upload documents here. Please note that the provided documents will be made public on a Council agenda.

Section 3 - Use of Funds

Annual grant amount being requested:

How will the City of Fort St. John and its contribution be recognized by your organization?

Section 4 - Details of Services

Describe the service your organization provides to the community:

Number of persons served annually by your organization:

Number of Fort St. John residents served annually by your organization:

Describe how your organization would utilize the grant funds and how it would benefit the community:

What other community support or sponsorship exists for your organization?

Section 5 - Declaration by Authorized Signatory

I hereby certify that I have read the City of Fort St. John Community Grants Policy No. 105 (linked below), that the application complies with its requirements, and that the information contained in the application is complete and correct.

I hereby agree to indemnify and save harmless the City of Fort St. John and its employees against all claims, liabilities, judgments, costs and expenses of whatsoever kind which may occur against the City and its employees in consequence of and incidental to, the granting of this exemption, if issued. I further agree to conform to all requirements of the applicable bylaw and all other statutes and all other bylaws in force in the City of Fort St. John.

IF THERE IS A CHANGE IN THE STATUS OF YOUR ORGANIZATION THE CITY OF FORT ST. JOHN MUST BE NOTIFIED.

Name:

Title:

Date:

By clicking the submit button below, you are confirming that the information you have provided is true and correct.

Verification Question(Please complete the CAPTCHA in order to submit this form)

The City of Fort St. John is committed to protecting your privacy. Any personal information you provide to us is collected pursuant to 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act for the purpose of administering City services.

Should you have any questions about the collection of this personal information please contact the Corporate Officer.

Fort St John

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Fee for Service Grant Application