Direct Funding Application Form


Please complete this form to request further information and we will contact you shortly. Please make sure you fill in all required (*) fields.

Name of Group *
Name *
Phone Number *
Email Address *
Address *

Delivery Address

Main Activity of the Group

Project/Programme for which the Grant is requested

Description of the Project
How much will the project cost?
Amount being requested
Amount the group has now
Date the grant is required by
Who will benefit from the grant?
Where do these people live?
Is the group willing to publicly acknowledge the support of Wiri Licensing Trust?
GST Registration Number (if applicable)
Cover Letter
Please attach a covering letter to help us better understand the project, number of people involved or attending, expected outcomes for the community and include photographs if appropriate.