Required fields are marked with asterisks (*)

Accessibility Improvement Grant Application Form

Town of Whitby - Accessibility Advisory Committee

Community Services 905.430.4310 • whitby.ca/accessibility

Name of Organization

Contact Person

Phone Number

Website

Mailing Address

Cheque made payable to:

Part B: General Information

Accessibility Improvement Project / Initiative summary

Type of Grant you’re requesting (select one):

Lead Grant matching dollars up to $10,000

Community Grant matching dollars up to $5,000

Education Grant up to $2,000

Enter (the approximate) dollar amount for the type of Grant you’re requesting.

Does your organization receive financial or in kind support from the Town of Whitby?

Yes

Has your organization made an application to the Mayor's Community Development Fund or Façade Grant Program in the past three years?

Yes

Part C: Applicant Business Case

Please answer the following questions. Explanations must be provided in the space provided on the application form.

Organizational summary, provide details appropriate to your organization?

What is your not-for-profit or non-profit organization's mandate / mission?

What type of business do you operate?

What educational project is your school undertaking?

Purpose of grant and how the funds will be used. An explanation of the improvement project, renovation, event or initiative – what the goal of the improvement is, and/or what the organization is trying to achieve.

What are the expected results / what will this grant achieve? The community impact of the improvement project, renovation, event or initiative, how it supports inclusiveness and how it makes a difference to the residents of the Town of Whitby.

Explain why your proposal is important, how it supports accessibility and inclusiveness and how your initiative will make a difference to the residents and visitors of Whitby.

What is the project duration? Please provide start and end dates along with key milestones.

How is this initiative being funded? Please provide projected dollar values, including organizational contributions.

Revenues ($)

Expenses ($)

Total Revenues ($)

Total Expenses ($)

Net (Revenues - Expenses) = $

Has other financial support or fundraising efforts been undertaken? Please explain. Funding efforts including how the improvement project, renovation, event or initiative will be funded beyond what the Town may provide and the importance of the Town’s

What are the implications if this grant is not approved?

The measure of success for the improvement project, renovation, event or initiative and a general explanation of what it means to have the Town of Whitby participate.

How will the success of this project be determined i.e., participant survey, reviews from local media, feedback from social media, increase or decrease in participation or volunteerism, other?

How is this grant going to help you sustain the program, service or access to your business or organization?

Fund Distribution:

All grants will be awarded in accordance to the Accessibility Improvement Grant Policy and Procedure. The approved grant amount will be issued to the applicant upon submission of the final report document and copies of paid invoices submitted to the Town. Cheques will be provided upon review of submitted documents.
Please note - the grant program does not reward poor stewardship. As a result, the Town of Whitby reserves the right to withhold payment of a grant to work/projects that are substandard or completed poorly; or that requires a building permit and inspections have not been conducted.

Part D: Authorized Signature

The applicant shall defend, indemnify and save harmless the Town of Whitby, its elected and appointed officials, employees and agents from any and all costs, claims, actions, loss, injury, expense, damages, fines or recoveries, liabilities and demands arising directly or indirectly from the acts or omissions of the applicant or any of its agents or employees in respect of or resulting from the application.