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

Street
 
Suburb
 
Town/City
 
Region
 
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.