Open to all Taranaki people up to and including 18 years of age.

Download Application Form or fill out the form below.

Name of Applicant

Email Address

Physical Address

Postal Address (if different from above)

Phone Day

Phone Evening

Phone Mobile

Fax

Date of Birth (as of application closing date)

Date:

Has the applicant been a resident in Taranaki for the past 12 months?
YesNo

Amount applied for?
$

Funding Area - Please tick which area you are submitting your request for:
HealthSportAcademicMusic/ArtsOther

Breakdown of Costs

Reason for application - Please state WHY you wish to apply in less than 100 words.

Purpose for application - Please state WHAT the grant would be used for in less than 50 words.


Will funding from other sources be required to complete or undertake the proposal?
YesNo

If yes, please indicate how much and where the additional funding is likely to come from:

Additional Funding Required
$

Breakdown of Costs
$

Possible source(s) of this funding


Have you applied for funding for this proposal from any other source(s)?
YesNo

If yes, please state who you applied to, how much was applied for and the outcome of your application:

Please make any additional notes in the space below and/or attach additional documentation, as you feel necessary:

Who can we contact if further information is needed?

Name

Phone Day

Phone Evening

Phone Mobile

Email


Declaration:I hereby declare that the information supplied is true and correct. I also acknowledge that if my application is successful, my name may be shown on the HATCH website, and in other HATCH promotional material.

Date:

Name of Parent/Guardian/Caregiver