Pemberton and District Initiative Fund Application Form

The Squamish-Lillooet Regional District (SLRD) Pemberton and District Initiative Fund (PDIF) is a fund established by the SLRD and the Village of Pemberton which is dedicated to the financial support of registered non-profit organizations whose activities will provide benefit to the residents of the Village of Pemberton and SLRD Electoral Area C. Support from the Regional District and Village is provided in the form of financial assistance only (i.e. cash contributions).

Financial support from local government is not provided to commercial (for-profit) businesses, retroactive funding for project expenses incurred prior to funding approval, debt retirement, reserves or mortgage pay downs, large scale capital and public infrastructure projects (with approved exceptions), ongoing fundamental operations of league or club-based sports programs, or prize money.

Financial assistance provided through PDIF may be used for wages, honorariums, contract services, promotions and marketing purposes, special events, projects and/or activities, and strategic or business plan development. Funding may also be used for the purpose of acquiring furnishings, equipment and supplies. Further information on eligible and ineligible program expenses is provided in the PDIF policy (SLRD Board Policy No. 16-2020 – Pemberton and District Initiative Fund Policy).

Please complete this application form and submit along with any additional information that may be of assistance to the SLRD no later than 4:00 pm on October 15 for Long-Term Agreement Funding. Incomplete applications will not be accepted.

After reviewing applications for completeness, staff will contact applicants with the next step in the process which may include a presentation to the Pemberton Valley Utilities & Services Committee.

Please note: Applications selected to go to the PVUS Committee are not guaranteed funding approval. Applicants will be kept informed of the status of their application. If approved by PVUS and/or the SLRD Board to receive funding, recipients are required to sign an agreement, provide evidence of appropriate insurance and fulfill the reporting requirements as outlined in the policy prior to disbursement of funds.

Application packages may be submitted by e-mail, mail or fax. Alternatively, applications can be submitted online through this digital application form.

The Squamish-Lillooet Regional District is committed to respecting and protecting the privacy of our website visitors. For more information, visit the SLRD Privacy Policy and Collection of Personal Information.

Organization Information

Application Date

Applicant Name

Registered Tax Charity # or Society Registration # (if applicable)

Date of last filing of annual report/bylaws with the provincial government (if applicable)

Applicant/Primary Contact Name

Primary Contact Phone #

Primary/Organization Mailing Address:

Address

Address 2

City/Town

Province

Postal Code

Primary Contact Email Address

Are all corporate filings with the provincial government up to date?

Yes

Applicant's Mission Statement or Key Goals

Details of Funding Request

1. Please identify the funding stream

Funding Stream

Arts, Culture and Recreation stream

Economic Development stream

2a. Annual funding requested $

2b. Total funding requested $

3. Total budget of the project, program or activity: $

4. Please attach a detailed budget, including: detailed cost estimates, sources of confirmed revenue, sources of revenue yet to be confirmed, sources of confirmed donations for labour and/or materials, and the most recent set of financial statements (if applicable). $

5. Name of project, program or activity needing support. Provide a description and identify how it will benefit, strengthen and enhance the well-being of the residents of the Village of Pemberton and SLRD Electoral Area C.

6. Describe the amount of revenues requested and received from all other sources, how these are used to support the program, project or activities under application, and how PDIF funds may be used to leverage additional sources of revenue.

7. Describe the organization’s administrative structure, including how funds are managed.

8. Describe how many persons and the geographic area the applicant serves, and how many people in the community are expected to benefit from the program, project or activities.

9. Explain the consequences if your PDIF application is not successful and what other options would be pursued.

10. Explain whether the organization has received funding from either the SLRD or Village of Pemberton in the past. If so, provide details of what it was for and for what amount.

11. Explain how the PDIF funding contribution would be publicly acknowledged if your funding application is successful.

12. Indicate the start date and end date of the program, project or activity, as applicable. (Please note that if approved, the SLRD disburses funds in August.)

Anticipated Start Date

Anticipated End Date

Detailed Project Budget Including:

• Detailed Cost Estimates
• Sources of Confirmed Revenue
• Sources of Unconfirmed Revenue
• Sources of Donations
• Any other Sources of Revenue

Detailed Project Budget

One file only.
512 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Most Recent Financial Statements (as applicable)

Society Documentation (e.g. current registration, bylaws, etc.)

Letters of Support (as applicable)

Additional Documents

Agree

Agree to attend PVUS Meeting to Present In-Person (as applicable)

Agree

Agree to Provide Project Update and Final Reporting Requirements

Agree

I understand that checking this box constitutes a legal signature

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