draft application 2013

7/29/2019 Draft Application 2013

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Please note Faxed, emailed, incomplete, unsigned or late applications will not be considered. All applications must be received by theclosing date in Wellington. Do not deliver or send applications to a Department of Internal Affairs regional office.

Application Form & Coversheet - 2013 Funding RoundThe intended outcome of the Community Development Scheme is strong, cohesive communities that are betterequipped to manage their own self-determined and sustainable development.

The purpose of the Community Development Scheme is to support communities who have identified their needs towork together in new ways, to be innovative, to generate their own solutions to local issues, and to become more self-reliant and resilient. It is designed to support community-driven projects that will enable people to come together,build trust and begin working towards achieving community outcomes.

The Community Development Scheme provides project grants to enable community organisations to employcommunity development project workers to facilitate the building of community capacity and capabilities and thedevelopment of a strong, sustainable community.

Before you start to fill out this form, please read the Community Development Scheme information published on The Department of InternalAffairs funding website:www.communitymatters.co.nz The information on the website will help you decide whether the project you areproposing is a good fit with the purpose of this funding scheme and will meet the eligibility criteria.

If you are using the downloadable Word document version of the Application Form, you will need to save this form and complete yourapplication on your computer.

Your application will be considered based on what you write on this application form. Record your answer to each question in the spacesprovided. If you wish to attach additional pages to complete your answer, please be sure to clearly mark the extra pages with the applicablequestion number.

Please note: your application will not be eligible if the application form is incomplete or any of the required information is missing. Pleaseensure that you have answered all the questions on the application form and all the required attachments are included.

The Department of Internal Affairs reserves the right to assign experts to assess any information provided with an application.

In submitting this application form you and/or the organisation you represent acknowledge and agree that the Department may disclose to,or obtain from, any other government department or agency, private person, or organisation, any information about the applicant.

Privacy

To view any personal information held by us, or if you have any concerns about personal information that we hold, please write to: ThePrivacy Officer, Department of Internal Affairs, PO Box 805, Wellington 6140.

Lodging an application

The next closing date for Community Development Scheme applications is

Wednesday 20 March 2013at4.00 pm

If sending your application by post

COMMUNITY DEVELOPMENT SCHEME APPLICATIONSCrown Funding Team, Community Operations,

Department of Internal Affairs, PO Box 805, Wellington 6140

If sending your application by courierCOMMUNITY DEVELOPMENT SCHEME APPLICATIONS

Crown Funding Team, Community Operations,

Department of Internal Affairs, Level 7, 22 The Terrace, Wellington 6011

COMMUNITY DEVELOPMENT SCHEME


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COMMUNITY DEVELOPMENT SCHEME APPLICATION FORM 2013 FUNDING ROUND

SECTION A: APPLICANT DETAILS

TO PROVIDE US WITH CONTACT INFORMATION FOR YOUR ORGANISATION

A1. Name of your organisation

Patumahoe Primary School

A2. Your organisations contact details

Postal address 38 Patumahoe Road,

Patumahoe RD4

PUKEKOHE 2679

Physical address

(if different from

the one above)

Phone 09 236-3802 Fax 09 236-3322

Email [email protected]

Website address www.patumahoe.school.nzA3. Key contact people - refer to Guide for Applicants for more information

Application contact person Paula Crosswell /Andrew Sinclair

Position in organisation

Daytime phone number Fax

Email

Governance contact person


Physical address


Email

Management contact person



Email


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SECTION B: ELIGIBILITY REQUIREMENTS FOR ORGANISATIONS

TO CONFIRM THAT YOUR ORGANISATION MEETS THE ELIGIBILITY REQUIREMENTS OF THIS SCHEME

B1. What is your organisations legal entity?Please tick the correct box. Refer to Guide for Applicants for more information

an INCORPORATED SOCIETY, registered under the Incorporated Societies Act1908Applicants must attach a copy of the current constitution, including any amendments and a copy of the Certificate ofIncorporation, referwww.companies.govt.nz

a REGISTERED CHARITABLE TRUST, registered under the Charitable Trusts Act 1957Applicants must attach a copy of the current trust deed, including any amendments and a copy of the Certificate ofIncorporation, referwww.companies.govt.nz

a SCHOOL BOARD OF TRUSTEES, established under the Education Act 1989a MORI TRUST BOARD, established under the Mori Trust Boards Act 1955a DISTRICT or CITY COUNCIL

a MORI COMMITTEE, MORI EXECUTIVE COMMITTEE or DISTRICT MORI COUNCIL, established under the

Mori Community Development Act 1962OTHER: Please specify legal status if different from those listed above - refer to Guide for Applicants for moreinformation

B2. What is the registered name of your organisation?(if different to your trading name)

B3. Is your organisation GST registered?(tick as appropriate)

YES / NO If YES, provide the GST registration number here:

B4. Does your organisation have its accounts audited each year?

YES / NO If YES, what is your financial year?

Attach the audited accounts for the two most recent financial years, includingthe Auditors reports.If the most recent set of audited accounts is more than nine months old at the time of applying, you must also provide:

the most recent monthly Treasurers or finance report, recording revenue and expenditure since the last auditedaccounts; - refer to Guide for Applicants for more information

a statement of current financial position, i.e. current assets and current liabilities and

a declaration, signed by two officers of your organisation, attesting to the accuracy of the financial update presented.

Name of Auditor

Company

Postal address

Phone number

B5. Is your organisation registered with the New Zealand Charities Commission?

YES / NO If YES, enter your registration number here:


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SECTION C: THE COMMUNITY DEVELOPMENT PROJECT PROPOSAL

TO IDENTIFY THE AIMS, OUTCOMES AND BENEFITS OF THIS PROJECT WITHIN YOUR COMMUNITYEach Project will be assessed for eligibility against the questions in this section

C1. i) Where will your project be located? - refer to Guide for Applicants for more information

In the geographical and social community catchment area of Patumahoe, a rural village locatednear Pukekohe in Franklin.

ii) Which specific community or communities, within the locality identified above, will be involved ?

The project intends to connect the different "local groups" within the wider catchment area toprovide long-term resiliency and sustainability in time of change.

The "locals" supported by the community development project include:

local residents and property owners, local business owners and employees, local schools and early childhood centres,

local sports clubs and members,

local interest groups and organisations and our local rural and natural environment.

Do we add Local Board?

C2. Why is there a need for this community development project in your community at this time?- refer to Guide forApplicants for more information

Patumahoe village is a long established rural community that is presently undergoing unprecedentedresidential development, after over a century of incremental growth. This growth has only been planned forin terms of some of the physical infrastructure such as water and sewage and allocation of areas forresidential development. However there has been no long term coordinated planning for the development ofthe central Village area, (given the unprecedented growth), and no assessment has been made on adverseeffects on the social capital, cultural and community networks and assets of the community. This growth hasonly been planned for in terms of physical infrastructure - and no assessment has been made on adverseeffects on the social capital, cultural and community networks and assets of the community.

This grant will allow for that deficiency to be overcome, and provide the emerging "new" community with thecharacter of the old, with strengthened resilience to not only withstand change - but thrive despite it.

As a well-serviced community - with amenities often worked for and maintained by volunteer efforts - it isregarded as the "local" of many of the residents from surrounding areas.

From the time that Franklin District Council approved a large Private Plan Change, and upgraded theinfrastructure, Patumahoe village has been identified as a growth node - firstly, by Franklin District Council,secondly, by the Auckland Regional Council, and more recently, by Auckland Council in its Auckland Plan.

Consideration of the effects of this growth on the community have not been identified either in the FranklinDistrict Growth Strategy (2004) or the Auckland Plan (2012). Residential subdivision in the last five years hasalready more than doubled the number of dwellings in the village itself, and if all identified growth areas aredeveloped - this added pressure on community values, ties and amenity will take place with little regard tothe current characteristics of this community.

With this in mind, in 2010 a two year project of community planning resulted in a robust Patumahoe VillageStructure plan that has identified common areas of concern and interest between residents, businesses,Patumahoe Primary School, Whakaupoko Landcare, Patumahoe Village Inc, and other communityorganisations and clubs. From the onset, a stated intent of inclusiveness and transparency was used to defineand implement a variety of methods to encourage wide participation, and a number of publications, meetingsand open days were held to report back regular progress and updates to the wider community. This StructurePlan with it's identified priorities and strategic projects, has utilised the available opportunities to engage

with Auckland Council, and will endeavour to continue in this direction.

While this effort has provided robust and adaptable priority issues, at present this valuable resource islimited by the amount of volunteer time that is able to be provided within the community.

With this grant, a coordinated effort can be undertaken to continue this consultative proactive approach to


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identify, maintain and strengthen existing community ties, and help provide resilience and growth in a timeof change. This process will also allow those involved to connect and participate outside of their currentinterest and sports groups and contribute to the grassroots development of the village. It will also encourageparticipation at any level from other members of the community.

For an indeterminate, but limited amount of time, an opportunity exists for the community to safeguard andstrengthen some of their identified community assets and valued resources. In particular, the strong link tothe central area of the village and the appreciation of the close natural environment, which will be limited inscope if surrounding development takes place without concern or appreciation of these values.

Patumahoe is peculiarly placed for innovative solutions to address these concerns as many of the presentlandowners of development land have been in discussion with Patumahoe Village Inc & Whakaupoko Landcarecoordinators, and are prepared to work with the community - if the opportunity presents itself - to safeguardand enhance identified community spaces.

This grant will allow a community that in the past has provided well utilised facilities and amenities, hasa proven kaitiakitanga of natural environment, the timely resources and ability to investigate andsupport alternative methods of doing so in a sustainable and effective way throughout and well past thisperiod of transition.

Attached: Patumahoe Village Structure Plan (2011)Attached: Patumahoe Village Submission to the Long Term Plan 2012-2022

Attached: Patumahoe Primary Enviroschools programmeAttached: Whakaupoko Landcare Summary document - Tui graph, pest and weed control.Attached: Walkway opening local paper articlesAttached: Email responses from Michael & Monique (Auckland Council participants at recent Field Day)


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C3. What is the overall aim or purpose of your project over the next three years? - refer to Guide for Applicants for moreinformation

Community Development Project: "Looking after the Locals"

During this time of change it is important that time is taken to ensure that the " locals " in our community aresupported and show resiliency in times of change, so the community can look forward to a sustainable future.

Locals include:- People - residents, business owners, visitors, sports players, students- Groups -educational groups, sports clubs, organisations, interest groups, historical groups etc- Community facilities - buildings, community spaces, community linkages etc, bumping places, parks &reserves- Looking after the local water, soil, food production, significant sites, landscapes, native flora and faunathat make up the productive and natural environments within our rural community.

C4. How will people in your community know about, and become involved in, your project? - refer to Guide for Applicantsfor more information

Local venue - Patumahoe Primary SchoolPatumahoe Primary School is located in the centre of the village, and is a pivotal part of community life. Theschool has offered the use of an office space for one morning each week, which will be manned by theemployed community worker for a regular time and day. This will provide regular scheduled opportunities forface to face and casual communication between the wider community and the project.

Direct organisational contactBetween the three partnership organisations of this scheme we have direct access to Patumahoe PrimarySchool students and their families via a weekly newsletter that goes out to all parents of children at theschool. Members of Whakaupoko Landcare and Patumahoe Village Inc receive emails.

PublicationsOur community website allows for online publication of meeting dates, minutes and any articles,correspondence or projects that the community may care to know about.

In addition, the grant will allow the project to reinstate a community printed newsletter for distributionwithin the village centre. This newsletter was produced at regularly intervals during the consultation processto ensure the best coverage of reporting back and inviting participation and distributed to 1600 properties,but cost prohibited continuation after the process completed.

All three organisations have published meeting notices and articles in local newspapers (of which there areseveral) and will continue to use this resource as a method of communication.

Public meetingsScheduled bi-monthly open meetings will allow the wider community to be heard and participate in decisionsrelating to priorities and implementation planning.

Local organisation workshops & training sessionsA series of workshops held for local sports, interest and other organisations will be used to provideinformation for volunteers, and to facilitate the use of common network and computer skills allowing aseamless integration of various groups to be accommodated and published on the community website. Byattending these sessions, or by being visited by the project development worker, not only will participantshave a direct method of publication themselves they will also be knowledgeable about opportunities for themto participate further.

An earlier smaller effort in this approach has resulted in the Whakaupoko Landcare group taking authorship ofthe environment pages on the website, and the formation of a local history group with contributions to thehistory section of the same site. Lack of volunteer time has restricted the further implementation of thismethod.


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Local BusinessA similar -- but adapted - method of engagement will be made to connect the business community withinPatumahoe. At present, there is no formal business organisation - but efforts to create and personalise acomprehensive local business directory on the community website will allow for direct contact with businessowners - and so - will inform, serve and provide an invitation for further participation. It is intended that ascheduled series of social and networking events will provide an opportunity for business owners to not onlyparticipate in the project, but consider the creation of a permanent business organisation.

Local Community Activities & EventsA series of community get-togethers will be planned, to invite participation and input at a social, casuallevel. These will take the form of potlucks, film nights, invited speakers etc. Different methods will be triedin order to reach and encourage the diverse range of people in the community.

Local ProjectsThere has already been some success in the project coordinated by Whakaupoko Landcare - Patumahoe's firstcommunity track, Te Ara O Whangamaire. The several working bees, and the official opening day attractedresidents and locals that were not affliated with any community group - but were pleased to take theopportunity to work together to create a community asset available to both the village and any visitors.There are several small projects that have been identified through the community consultation process, thatwould act as both a catalyst for community participation, and a provider of ongoing benefits to the widercommunity.

Word of mouthThere are many opportunities for people to get together and discuss ideas and come up with solutions. Bykeeping as many stakeholders informed as we can identify, we hope to reach as many of our locals aspossible. We have found that these discussions between acquaintances and friends are often veryproductive.

Community noticeboardThere is a need for a community noticeboard, allowing for posting of local notices and news. At presentthere is an ad-hoc noticeboard in one of the local shops, but this is often overcrowded with no room toexpand. If a suitable site and design can be identified and approved, this noticeboard would act a point ofreference for local news, and will be able to continue this function after the community development projectis complete.

Attach any supporting documents that demonstrate community support for this project proposal. This may include the minutes of any meetings orconsultation undertaken in the community prior to lodging this application. However, if letters of support are presented, they must be specific to theapplication to the Community Development Scheme. Letters of support not related to the project proposed will be returned.

C5. Do you have any other organisations or project partners involved in this proposal at this stage?

YES / NO If YES, please provide details of who they are and how they will be involved.If NO, how will you let other organisations / potential partners know about your project and involve them in it?

Patumahoe Village Inc, who has invited participation and collaboration with the school on thedefinition and production of the Patumahoe Village Structure Plan (2011), and who has kept usinformed not only of progress on matters that impact the school but on wider community issues.As existing partners of Whakaupoko Landcare, not only does their documented Structure Plan andcouncil submissions play a role in providing strategic direction and priorities, their commitment toinclusiveness and transparency of process fits well within the project intent. This is for instanceexampled by the familiarity already of instigating the likes of street parties and large open days tofoster community consultation and interaction.

This three-way collaboration on this project, initiates the wider process of inclusion, and can createefficiencies by avoiding duplication, which in turn may facilitate innovative solutions.

As committed participants of the Enviroschools programme this project meets the criteria thatensures that programmes are participatory, locally relevant and responsive to change. It providesflexibility for priorities to evolve to meet the needs of children and young people, their schools and

their communities.

This project will allow the realisation of the collective vision of the project partners:"to provide a sustainable outcome for Patumahoe "locals" - whether they be existing or recentresidents, members of the school community, business owners and operators, sports clubs, interestgroups, Playcentre or other organisations, our local flora & fauna, and both our community spaces


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and natural environment.

Whakaupoko Landcare (a local environmental group established in 2004) - who since that time hasworked in partnership with the school in the past providing both organisations with resources andresults that would not have been achieved independently. As well as regeneration, weed and pestcontrol, and bird survey projects, a recent Whakaupoko Landcare project created a communitywalkway in close vicinity to the school that provides access to two natural bush reserves acrossprivate land. Patumahoe School was the host of the opening day ceremony, and students activelyparticipated in the creation of the walkway alongside the wider community. The wider community

also included representatives from the local Iwi, (Ngati Tamaoho and Ngati Te Ata), who officiated atthe opening ceremony and kindly helped us in providing a name for the Walkway, (Te Ara OWhangamaire).

Whakaupoko Landcare has continued to expand and thrive for over 9 years despite almost a 100%reliance on volunteer input. Monitoring has been a cornerstone of the group since 2006, (birds andpests), to provide valuable feedback to participants and funding providers, (we have receivedassistance for some material costs). Their efforts are well respected by many in the wider communitywith for instance very supportive emails from Auckland Council staff following a Whakaupoko Fieldaythey attended, held recently on March 2nd. This was looking at pest control and discovering ourLocal long tailed bat. Also for instance 2 members last year gave presentations at the NZ LandcareTrust inaugural 3 day Conference at Hamilton last year on Simple Monitoring techniques that thegroup has been responsible for developing with wide industry consultation.

C6. Over a potential project period of three years, what do you think will be the main outcomes of your projectfor your community?- refer to Guide for Applicants for more information

Outcome 1:A local community culture that is resilient in times of unprecendented change.

People matter, there is a greater sense of inclusion, caring and belonging. There is a culture ofWe and Our and not I and my

An initial priority will be to recognise and support resilient community networks in Patumahoe, thataccommodate the large increase in "new locals" while acknowledging the "established localcommunity".

To increase the level of social capital by developing and supporting Patumahoe's social andcommunity infrastructure.

To facilitate the inclusion of any marginalised groups or individuals by deliberate and diversemethods of encouraging participation.

Commitment to transparency of process and inclusive decision making. Also to keep all localsinformed of the planning and project processes as they occur, and this will be further enforced byregular reviews and publications allow for ongoing discussions.

Regular opportunities will be provided for all to participate in long-term visioning and sustainabilityinitiatives.

Outcome 2: A rural village with a "green heart" - recognising, protecting and enhancing ourcommunity spaces.

A well planned, vibrant central Village area with a "green heart" is developed. There are lots ofbumping places and the central area is a magnet to all people

The most common identified priority in the Patumahoe Village Structure Plan (2011) was the needto preserve and enhance the existing green community spaces in the centre of the village, thataccommodates both the residential and business growth that has been identified and permitted bycouncil policy but has not as yet been assigned physical space.

Investigation of different models to achieve this long-term goal will need to be made and optionspresented and discussed within the wider community.

An advantage of discussion of this long-term project is that involved participants -whetherindividuals or groups will gain a wider and longer-term perspective, and can develop and implementtheir own local and smaller projects as stepping stones towards a greater cohesive plan.


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Outcome 3: Increased community access to - and participation in - the improved quality of ourlocal rural and natural environment.

In October 2013, a community initiated walkway was opened due to the coordinator efforts ofWhakaupoko Landcare, who provided the initiative, oversight and programme allowing otherorganisations and individuals to participate.

It was apparent that many residents participated because this was an opportunity to contribute to aproject that provides ongoing community benefits. This results in the creation of a physical asset as

well as a stronger community.

There is a growing awareness in our community that in the wider Manukau Ecological District only1.6% of the land remains in its original state. This does not make for a healthy environment orhealthy community as we look to connect more with the food we eat and our local environment andat the same time manage the rapid human growth.

Several projects and events have been identified but have been unable to be acted on because oflack of volunteer time for the coordination that is required.

Outcome 4: Develop a Patumahoe Village "healthy green heart-wise" programme - taking careof our "local community" and our "local planet' in the long term.

The development of the Patumahoe district that is more in line with a Sustainable Eco Village.The Village and surrounding area is future-proofed for a growing trend back toward Local,Sustainable and less dependence on fossil fuels.

We will embrace and take ownership of our destiny and direction as a community, and look for thesolutions to come from within.

In order to achieve this, we intend to provide education, local initiatives and opportunities for thelocal community to find long-term sustainable solutions to reduce fossil fuel reliance, and futureclimate change impact.

We will look to find solutions for more efficient utilisation of resources within the community, sohabits can be formed that benefit all in the long term.


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Long-term outcome one A sustainable local community that is resilient and self-directed in times of unpreced

Short-term outcomes (forfirst year only)

Planned initiatives to achieve thisoutcome (for first year only)

Planned activities for each initiative

Review and possible re-edit of identified

priorities in PatumahoeVillage Structure Plan -produced in 2011 - afterextensive consultationand feedback

Once the preceding short-termoutcome have been achieved it is

necessary to review and perhaps editexisting priorities and projectsidentified in the Patumahoe VillageStructure Plan

1.Depending on the success of the initiativesabove - a combination of methods will be

chosen to encourage the fullest participationof stakeholders in the review discussion ofpriorities.2. Publication and discussion of new prioritieswithin the wider community using a variety ofmethods including online, newsletters, mailinglists, noticeboard.


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Long-term outcome three Increased community access to - and participation in - the improved quality of our lo

Short-term outcomes (forfirst year only)

Planned initiatives to achieve thisoutcome (for first year only)

Planned activities for each initiative

Educate the localcommunity of thebenefits and methodsthey can take to protect,enhance and enjoy theirlocal environment.

Increase the number of workshops,information sessions and field days heldby Whakaupoko Landcare.

1. Pest & weed control workshops and workinbees.2. Field days

3. Bird surveys

Complete alreadyidentified communityproject that enhance ourlocal natural or ruralenvironment.

Refer to the Patumahoe VillageStructure Plan (2011) to identifyreasonably achievable communityprojects that will be able to becompleted within the first year.

1. Complete carving for first communitywalkway - Te Ara O Whangamaire.2. Define and build seating at top of Puff'sHill.3. Identify and begin next community project

Wider community

participation inPatumahoe PrimarySchools Enviroschoolsprogramme, and theirown Paddock to Plateinitiative.

Use all methods of publication and

email networks to advise localcommunity of opportunities to supportand participate in the Enviroschools andPaddock to Plate initiatives.

1. Support Enviroschool programme by invitin

participation from whole community.


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COMMUNITY DEVELOPMENT SCHEME APPLICATION FORM 2013 FUNDING ROUND 15

C8. The scheduled start date for projects in this funding round should not be prior to 1 July 2013.If this application issuccessful, when would you propose to start your project?

1 July 2013.

C9. What is the proposed budget (excluding GST) for your project in its first year?With respect to presenting the Budget for the first yearof your proposed project, please note that:

the maximum project grant available from the Community Development Scheme is $80,000.00 per year exclusive of GST;

the grant provided is primarily to cover the salary, project support and administrative costs directly related to the communitydevelopment project;

use of the grant for the purchase of major capital items, such as motor vehicles, is not allowed; and,

all the figures presented should be exclusive of GST - GST will be paid in addition to any grant provided.

PROJECT INCOME:

Community Development Scheme Grant: Year One 80,000

Total (excluding GST) $80,000

PROJECT EXPENDITURE:

Community Development Project Workers salary/invoices $50,000

Accident Compensation Corporation (ACC); Kiwisaver etc

Patumahoe School administration fee $1,000

Accounting fee $1,000

Project administration and secretarial fees $1,500

Project costs - for community defined and initiated projects $15,000

Communication & publication costs $2,000

Events & activities - that create "bumping" opportunities and allow an informal and

welcoming engagement of wider community members

$8,000

Website: upgrade, content loading and maintenance costs $1,500

Travel costs

Total (excluding GST) $ 80,000


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SECTION D: ABOUT YOUR ORGANISATION

WHY YOUR ORGANISATION SHOULD BE SELECTED TO HOST A COMMUNITY DEVELOPMENT SCHEME PROJECT

Each applicant organisation will be assessed for eligibility against the questions in this section -- refer to Guide for Applicants for moreinformationD1. What experience does your organisation have of delivering projects within or on behalf of the community?

to be completed with the participation and input of Patumahoe Primary School/Ron Gordon.

D2. i) How does your organisation work and where will this project fit within your organisation and your community? Diagram attachment required how/where this project will fit within your organisation - refer to Guide for Applicants

DIAGRAM NEEDED

Diagram attachment required how/where this project will fit within your community - refer to Guide forApplicants

ii) Are any of the trustees or members of your governance structure also employed as staff?

YES / NO If YES, please provide details of whom they are and which positions they hold? - refer to Guide for

Applicants


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Attach copies of the Conflict of Interest policies and procedures for people at the governance, management andemployee levels of your organisation - refer to Guide for Applicants

to be filled in using Patumahoe Primary school policies and protocols

iii) Will this project involve close family members, relations or other close associates of your organisation?

YES / NO If YES, please provide details of whom they are and which positions they hold?



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D3. i)Please describe the financial systems and controls proposed for this project. - refer to Guide for Applicants


ii) Who will be the signatories to cheques for this project?

Name


NamePosition in organisation

iii) Bank account details

Bank

Branch

Branch address

Account number

D4. If this application is successful, how will you advertise and what processes will you follow to identify and recruit an

appropriately skilled Community Development Worker for this project? - refer to Guide for Applicants



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D5. Referees

Pleaseidentify two key people within your community that The Department of Internal Affairs may contact to discuss your

organisation, this project proposal and the capacity of your organisation to host a Community Development Scheme project

within your community.- refer to Guide for Applicants

Referee OneName Ron Gordon

Position Principal

Organisation Patumahoe Primary School

Physical address 38 Patumahoe Rd, R D 4, Pukekohe 2679

Daytime phone number 09 236 3802

Fax 09 236 3322

Email ron.gordon@@patumahoe.school.nz

Referee TwoName

Position

Organisation

Physical address

Daytime phone number

FaxEmail


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SECTION E: DECLARATION FOR YOUR ORGANISATION

E1. Declaration

This declaration must be signed by two people from the applicant organisation who are 18 years of age or

older, with authority to sign on behalf of the organisation. Signatories cannot be an un-discharged

bankrupt, be immediately related or partners and cannot live at the same address. They must have a

daytime contact phone number and be contactable during normal business hours.

We the undersigned declare the following:

The details given in all sections of this application are true and correct to the best of our knowledge.

We have the authority to commit our organisation to this application.

The organisation we represent acknowledges and agrees that The Department of Internal Affairs

may disclose to, or obtain from, any other government department or agency, private person or

organisation, any information about the organisation we represent for the purpose of gaining or

providing information related to funding.

We will inform The Department of Internal Affairs of any significant changes in our organisation orimpacting on the proposed project between the date of this application and the date of the decision-

making on the applications, such as any change in contact details; office holders; the financial

situation of the applicant organisation; an intention to wind-up or cease operations; or any other

significant event.

We have the following internal controls in place:

two signatories to all bank accounts;

a regularly maintained and current cashbook or electronic equivalent;

a person responsible for keeping the financial records of the organisation;

a regularly maintained tax record;

a regularly maintained P.A.Y.E. record; grants and expenditure of grants shown as separate entries in the cash book or as a note to

the accounts; and

regular financial reporting to every full meeting of the governing body.

We will not receive a salary or any other pecuniary gain from the proceeds of the grant monies.

All reasonable information has been provided to support our application.

Signatory 1

Name



Alternate phone number

Signature..Date / /

Signatory 2

Name



Alternate phone number

Signature..Date / /

draft application 2013

Documents