Alberni-Clayoquot Region Grant-In-Aid Application Form
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1
2
3Grant-in-Aid
Application Form
Name of Organization
Mailing Address:
Contact Name:
Phone Number:
:
Email Address
G
G
Grant Requested:
Grant Assistance
In-Kind Assistance
$ ___________
_____________________
Amount
Details:
G yes
G no
1.
Is your organization non-profit?
G yes
G no
2.
Is you organization a registered non-profit society in BC
If yes, please provide your Society Registration Number:
______________
3.
Please describe the services and benefits that your organization provides to the Alberni-
Clayoquot Region:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
4.
Which of the following areas in the Alberni-Clayoquot Region receive a benefit from the
services your organization provides:
G
G
Entire Regional District
City of Port Alberni
G
G
District of Tofino
District of Ucluelet
G
G
Electoral Area “A”
Electoral Area “B” (Beaufort)
(Bamfield)
G
G
Electoral Area “C”
Electoral Area “D” (Sproat Lake)
(Long Beach)
G
G
Electoral Area “E”
Electoral Area “F”
Creek)
(Beaver Creek)
(Cherry
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