HomeMy Public PortalAbout2016-17_Guidelines_Municipal Grants Program
Municipality of the District of Chester
Grant Guidelines
The Municipality of the District of Chester recognizes the importance of community organizations and
the positive impact they have on the well-being and growth of the community. Grant programs are
developed to offset some of the financial burden borne by community organizations as they strive to
fulfill their mandates.
The Municipality has several grant programs to support organizations and families including:
1. Council Grant
2. Tourism Grant
3. Major Project Grant
4. Recreation Grant
5. PRO Kids
6. Youth Sponsorship Grant
The intent of these guidelines is to provide a clear understanding of the various grant programs offered
by the Municipality. Below is a description of each grant program and their unique criteria and
application procedure. Please read these guidelines thoroughly to ensure you are applying for the
correct funding program.
Municipal Council strives to treat all organizations fairly and consistently and to share resources
throughout all areas of the Municipality.
Please Note:
Organizations are only eligible for one grant from the Municipality of the District of Chester
within a fiscal year.
COUNCIL GRANT
The Municipality of the District of Chester values the contributions provided through the volunteer
efforts of community organizations. The Municipality is committed to assisting community
organizations by providing grant funds to support various projects, activities and services.
Eligibility
- You must be a non-profit organization, or otherwise comply with the requirements of the
Municipal Government Act for eligibility for a grant or contribution by a municipality (Section
65(AU)).
- Your primary purpose must be to operate, sponsor or encourage programs, activities or facilities
within the Municipality of the District of Chester.
- Applicants must demonstrate that the project, activity or facility is open to all Municipality of the
District of Chester residents.
- Organizations are only eligible for one grant from the Municipality each fiscal year, regardless of
grant type.
- Royal Canadian Legions located with the Municipality may apply for grant funding to support
programs and events which are open to the public. General operating expenses or capital
improvements will not be considered.
- Churches / faith based organizations are not eligible for funding. Council may make exceptions if
the organization is the only one in the area providing the service, in such cases general operating
expenses or capital improvements will not be considered.
- Private member based organizations, whose primary focus is to serve its members, are not
eligible for funding. Council may make exceptions on occasion where programs or initiatives are
open to the general public.
Application Procedure
- Grants will be reviewed in June and November. Applications must be submitted by May 31st or
October 31st.
- Applications that are emergency in nature will be accepted at any time.
- Organizations must complete the Council / Tourism Grant Application form.
- You may attach a separate document if there is insufficient space on the form for your response
to each question.
- The application form must be completed in full and have appropriate signatures.
- Completed application forms should be submitted to the Municipality as indicated on the
application form.
- Council will review all applications and determine funding amounts.
- If organizations have questions about the application form or would like to receive assistance in
completing the form, please contact the Recreation & Parks Director at 902-275-3490 or
chaughn@chester.ca.
- After a project is complete, organizations are required to submit a completed Council Grant
Report Form to indicate how the funds were spent.
Funding
- The amount of total grant funding available for Council Grants each year will be determined
during annual budget deliberations.
- The maximum funding limit for Council Grants is $10,000.
Evaluation
Applications will be reviewed using the following evaluation criteria:
- Benefit to the community at large.
- Demonstrated positive community impact.
- Financial need of the organization for grant funding.
- Evidence of fundraising efforts (there are funding sources other than the Municipality).
- Project alignment with the Municipal strategic plan.
TOURISM GRANT
Tourism is an important economic generator for the Municipality of the District of Chester and
community organizations often contribute to the growth of the tourism sector. The Tourism Grant
program is available to assist organizations with tourism development and promotion related projects
designed to enhance the visitor experience and make our community a more appealing destination. The
goal of visitor attraction is to motivate people to travel to our community for high quality experiences
and then stay longer and spend more during their stay.
Eligibility
- The project, activity or event must be designed to enhance the visitor experience or increase the
appeal of the Municipality of the District of Chester as a destination.
- The project must make a positive contribution to visitor attraction within the Municipality of the
District of Chester.
- You must demonstrate evidence of visitor attraction using past success or specific plans for
visitor attraction to the event.
- You must be a non-profit organization, or otherwise comply with the requirements of the
Municipal Government Act for eligibility for a grant or contribution by a municipality (Section
65(AU)).
- You may attach a separate document if there is insufficient space on the form for your response
to each question.
- Applicants must demonstrate that the project, activity or event is open to all Municipality of the
District of Chester residents and it must entice visitors to the area.
- Organizations are only eligible for one grant from the Municipality each fiscal year, regardless of
the grant type.
- Churches / faith based organizations are not eligible for funding. Council may make exceptions if
the organization is the only one in the area providing the service, in such cases general operating
expenses or capital improvements will not be considered.
- Private member based organizations, whose primary focus is to serve its members, are not
eligible for funding. Council may make exceptions on occasion where programs or initiatives are
open to the general public.
Application Procedure
- Grants will be reviewed in June and November. Applications must be submitted by May 31st or
October 31st.
- Organizations must complete the Tourism / Council Grant Application form.
- The application form must be completed in full and have appropriate signatures.
- Completed application forms should be submitted to the Municipality as indicated on the
application form.
- Council will review all applications and determine funding amounts.
- If organizations have questions about the application form or would like to receive assistance in
completing the form, please contact the Recreation & Parks Director at 902-275-3490 or
chaughn@chester.ca.
- After a project is complete, organizations are required to submit a completed Tourism Grant
Report Form to indicate how the funds were spent.
Funding
- The amount of total grant funding available each year for Tourism Grants will be determined
during annual budget deliberations.
- The maximum funding limit for Tourism Grants is $5,000.
Evaluation
Applications will be reviewed using the following evaluation criteria:
- Benefit to the community at large.
- Demonstrated positive community impact (specifically tourism and economic impact).
- The organization has a financial need for grant funding.
- Evidence of fundraising efforts (there are funding sources other than the Municipality).
- Project alignment with the Municipal strategic plan.
MUNICIPALITY OF THE DISTRICT OF CHESTER
GRANT APPLICATION FORM
Council or Tourism Grant Request
Name of Organization
Applying
Contact Person
Position with Organization
Mailing Address
Incorporation Number with Registry of Joint Stocks
(if applicable)
Phone: Fax:
Email: Date:
Type of Grant Council Grant ____ OR Tourism Grant _____
Signature of Signing Officer(s) and their position with Organization:
Name Signature Position
_______________________________________ _______________________________________ ___________________________________
_______________________________________ _______________________________________ ___________________________________
ORGANIZATION AND/OR EVENT INFORMATION:
1. Purpose or objective(s) of your organization (i.e. mission statement):
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
2. For Council Grants - Please provide an outline of the project and its benefits to residents.
For Tourism Grants - Please provide an outline of how the project will improve visitor attraction and
benefit the local economy in the Municipality (attach separately if insufficient space).
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
3. How much money are you requesting? $__________________________________________
4. Budget
Please attach a project budget showing all revenue and expenses.
You must demonstrate fundraising efforts and include a list of financial contributions from all
sources.
If your project exceeds $5,000, please include a copy of your most recent yearly financial
statement.
If your organization has a reserve account or large amount of savings for a designated
project, please note the purpose or intended use of those funds.
5. How do you plan to spend any Council / Tourism Grant funding received?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
7. Is your grant request time sensitive (for example, an event on a specific date)?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
8. Is there additional information that may support your grant application? Please attach letters of
support, etc.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
9. Did your organization receive funds last year from the Municipality of the District of Chester?
Yes _____ No _____
If yes, was it a Council Grant _____ Recreation Grant _____ Tourism Grant _____
How much was the grant? $___________________________________
(Please attach a copy of completed report form if not previously submitted)
APPLICATION CHECKLIST - DID YOU INCLUDE WITH YOUR APPLICATION:
____ A written outline of the project and its benefits to residents
____ Project budget including Revenues and Expenses
____ Financial Statement (for projects exceeding $5,000)
____ Incorporation Number (if applicable)
____ List of Directors
____ Application signed by signing officer(s)
____ Copy of report regarding previous year’s grant (if a grant was received last year)
If you require assistance, please contact the Municipal Office at:
Phone (902) 275-3490 Fax (902) 275-3630 Email chaughn@chester.ca
REPORT TO COUNCIL - HOW WAS YOUR EVENT AND HOW WERE THE FUNDS SPENT?
Following your event or upon the completion of your project it is requested that you provide a very brief
report regarding the project and how the Grant money was spent. If a follow-up report is not received
future requests may be affected.
Please forward applications and reports to the following: Director of Recreation & Parks
“Grant Report”
Municipality of the District of Chester
PO Box 369
Chester, NS B0J 1J0
OFFICE USE ONLY
Essential Services
Regional Services
Local Non-Profit
Community Halls
National/Provincial,
Cultural/Health Services
Report Received
MAJOR PROJECT GRANT *NEW*
The Municipality of the District of Chester provides financial assistance for major community projects
that involve a more significant level of funding than is covered under Council Grants. These projects
may include the construction of a new facility, renovation of an aging facility, purchase of large capital
items or the development and implementation of substantial community wide programs or initiatives.
Eligibility
- You must be a non-profit organization, or otherwise comply with the requirements of the
Municipal Government Act for eligibility for a grant or contribution by a municipality (Section
65(AU)).
- Your primary purpose must be to operate, sponsor or encourage programs, activities or facilities
within the Municipality of the District of Chester.
- Organizations are only eligible for one grant from the Municipality each fiscal year, regardless of
grant type.
- Only projects valued at $10,000 or more will be considered under this program. Projects valued
at $10,000 or less will be considered under the Council Grant program.
- Churches / faith based organizations are not eligible for funding. Council may make exceptions if
the organization is the only one in the area providing the service, in such cases general operating
expenses or capital improvements will not be considered.
- Private member based organizations, whose primary focus is to serve its members, are not
eligible for funding. Council may make exceptions on occasion where programs or initiatives are
open to the general public.
Application Procedure
- Applications must be received by March 31, 2016 for projects taking place in the 2016-2017 fiscal
year. In future years groups will be required to submit Major Project Grant application by
January 31st for the following fiscal year.
- Organizations must complete the Major Project Grant Application form.
- You may attach a separate document if there is insufficient space on the form for your response
to each question.
- If the project is new construction or facility renovation you must comply with all applicable
municipal, provincial and federal regulations and you are required to show proof of ownership or
long term lease.
- The application form must be completed in full and have appropriate signatures.
- Completed application forms should be submitted to the Municipality as indicated on the
application.
- Council will review all applications and determine funding amounts.
- If organizations have questions about the application form or would like to receive assistance in
completing the form, please contact the Recreation & Parks Director at 902-275-3490 or by email
at chaughn@chester.ca.
- After a project is complete, organizations are required to submit a completed Major Project
Grant Report Form to indicate how the funds were spent.
Funding
- The amount of grant funding available each year will be determined during annual budget
deliberations.
- There is no maximum funding limit for Major Project Grants.
Evaluation
Applications will be reviewed using the following evaluation criteria:
- Benefit to the community at large.
- Demonstrated positive community impact.
- The organization has a financial need for grant funding.
- Evidence of fundraising efforts (there are funding sources other than the Municipality).
- Project alignment with the Municipal strategic plan.
MUNICIPALITY OF THE DISTRICT OF CHESTER
GRANT APPLICATION FORM
Major Project Grant Request
Name of Organization
Applying
Contact Person
Position with Organization
Mailing Address
Incorporation Number with Registry of Joint Stocks
(if applicable)
Phone: Fax:
Email: Date:
Signature of Signing Officer(s) and their position with Organization:
Name Signature Position
_______________________________________ _______________________________________ ___________________________________
_______________________________________ _______________________________________ ___________________________________
ORGANIZATION INFORMATION:
1. Purpose or objective(s) of your organization (i.e. mission statement):
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
2. Is your project: New Construction ______ Renovation ______ Equipment ______ Program ______
3. Please describe your project and its benefits to residents (attach separately if insufficient space).
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
4. If your project is new construction or renovation, who are the main users of the facility and for what
purpose will they use it? If your project is program based, who is the target audience?
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
5. How much money are you requesting? $__________________________________________
6. Budget
Please attach a project budget showing all revenue and expenses.
The budget must include all sources of funding.
Please include a copy of your most recent yearly financial statement.
7. For construction or renovation projects, please specify whether you own the facility or have a long
term lease.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
8. Is there additional information that may support your grant application? Please attach letters of
support, etc.
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
9. Did your organization receive funds last year from the Municipality of the District of Chester?
Yes _____ No _____
If yes, was it a Council Grant _____ Recreation Grant _____ Tourism Grant _____
How much was the grant? $___________________________________
(Attach copy of report if not previously submitted)
Application Checklist: DID YOU INCLUDE WITH YOUR APPLICATION:
____ A written outline of the project and its benefits to residents
____ Project budget including Revenues and Expenses
____ Previous Years Financial Statement
____ Incorporation Number (if applicable)
____ Application signed by signing officer(s)
____ Copy of report regarding previous year’s grant (if a grant was received last year)
If you require assistance, please contact the Municipal Office at:
Phone (902) 275-3490 Fax (902) 275-3630 Email chaughn@chester.ca
REPORT TO COUNCIL - HOW WAS YOUR EVENT AND HOW WERE THE FUNDS SPENT?
Following the completion of your project it is requested that you provide a very brief report regarding the
project and how the Grant money was spent. If a follow-up report is not received future requests may be
affected.
Please forward applications and reports to the following: Director of Recreation & Parks
“Grant Report”
Municipality of the District of Chester
PO Box 369
Chester NS B0J 1J0
OFFICE USE ONLY
Essential Services
Regional Services
Local Non-Profit
Community Halls
National/Provincial,
Cultural/Health Services
Report Received
RECREATION GRANT
Many of the recreation, sport and cultural opportunities available within the Municipality are delivered
by the community. The role of the Municipality is to support these organizations that contribute to the
quality of life for local residents. The Recreation Grant program is designed to build the capacity of
volunteer organizations by providing financial support for the creation and expansion of recreation,
sport and cultural programs, events and facilities within the Municipality.
Eligibility
- You must be a non-profit organization, or otherwise comply with the requirements of the
Municipal Government Act for eligibility for a grant or contribution by a municipality (Section
65(AU)).
- Projects or initiatives for which funding is requested shall be the creation or expansion of
recreation, sport or cultural programs, events, facilities and equipment within the Municipality.
- Operating expenses are not eligible for funding, with the exception of expenses related to
maintenance (not operational) of existing facilities and equipment are eligible for funding.
- Organizations are only eligible for one grant from the Municipality each fiscal year, regardless of
grant type.
- You must guarantee community access to facilities, programs and activities.
- If you do not fit the criteria but are the only group in the area providing recreation related
services, you may be considered.
- If you are not incorporated you are eligible for a maximum of $50.00.
- Financial assistance should not be anticipated on an annual basis.
- Royal Canadian Legions located with the Municipality may apply for grant funding to support
programs and events which are open to the public. General operating expenses or capital
improvements will not be considered.
- Churches / faith based organizations are not eligible for funding. Council may make exceptions if
the organization is the only one in the area providing the service, in such cases general operating
expenses or capital improvements will not be considered.
- Private member based organizations, whose primary focus is to serve its members, are not
eligible for funding. Council may make exceptions on occasion where programs or initiatives are
open to the general public.
Application Procedure
- There is one application deadline and the date is set annually. Normally the deadline is within
the first or second week in October.
- Organizations must complete the Recreation Grant Application form.
- You may attach a separate document if there is insufficient space on the form for your response
to each question.
- The application form must be completed in full and have appropriate signatures.
- Completed application forms should be submitted to the Municipality as indicated on the
application.
- The Recreation & Parks Committee will review all applications and make a recommendation to
Municipal Council for final approval.
- If organizations have questions about the application form or would like to receive assistance in
completing the form, please contact the Recreation & Parks Director at 902-275-3490 or by email
at chaughn@chester.ca.
- Applications must be submitted prior to the deadline. Public notification will be provided of the
submission dates.
- After a project is complete, organizations are required to submit a completed Recreation Grant
Report Form to indicate how the funds were spent.
Funding
- The amount of grant funding available each year will be determined during annual budget
deliberations.
- Organizations that receive funding must submit a completed Grant Report Form to indicate the
success of the project and how the funding was spent.
Evaluation
Applications will be reviewed using the following evaluation criteria:
- Benefit to the community at large.
- Demonstrated positive community impact.
- The organization has a financial need for grant funding.
- Evidence of fundraising efforts (there are funding sources other than the Municipality).
- Project alignment with the Municipal strategic plan.
MUNICIPALITY OF THE DISTRICT OF CHESTER
GRANT APPLICATION FORM
Recreation Grant Request
Name of Organization Applying
Contact Person
Position with Organization
Mailing Address
Incorporation Number with Registry of Joint Stocks
(if applicable)
Phone: Fax:
Email: Date:
Signature of Signing Officer(s) and their position with Organization:
Name (printed) Signature Position
________________________________________ ________________________________________ ____________________________________
________________________________________ ________________________________________ ____________________________________
ORGANIZATION AND PROJECT INFORMATION:
1. Purpose or objective(s) of Organization (i.e. mission statement):
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
2. Please provide an outline of the project and its benefits to residents (attach separately if insufficient
space).
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
3. How much money are you requesting? $________________________________
4. Budget
Please attach a project budget showing all revenue and expenses.
Show fundraising efforts and include a list of financial contributions from all sources.
Include a copy of your most recent financial statement.
5. How do you plan to spend any Recreation Grant funding received?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
6. Is there additional information that may support your grant application? (You may attach additional
information).
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
7. Did your organization receive funds last year from the Municipality of the District of Chester?
Yes _____ No _____
If yes, was it a Council Grant _____ Recreation Grant _____ Tourism Grant _____
How much was the grant? $___________________________________
APPLICATION CHECKLIST - DID YOU INCLUDE WITH YOUR APPLICATION:
Incorporation number
Information on how funds will be used
Project Budget
Financial Statement
Application signed by signing officer(s)
If you require assistance, the Recreation & Parks Director will gladly help you.
Recreation & Parks Director Email: chaughn@chester.ca
“Recreation Grant” Fax: 902-275-3630
Municipality of the District of Chester Phone: 902-275-3490
PO Box 369
Chester NS B0J 1J0
POSITIVE RECREATION OPPORTUNITIES FOR KIDS (PRO KIDS)
The PRO Kids program is designed to provide assistance to children and youth who are not able to
participate in sport, recreation and cultural activities due to financial constraints. The target group for
this grant is low income families who would otherwise not be able to afford to enroll their children in
these programs.
Eligibility
- Parents or Guardians may apply on behalf of a child who is 0-18 years of age.
- The child must live within the Municipality of the District of Chester.
- Applicants may request assistance with registration fees and/or equipment costs.
- The applicant must be registered with an organized community group in order to receive
financial assistance.
- Approval is based on a Reference System. Applicants must provide the name of a reference that
is familiar with their personal and financial situation and who can verify that the applicant
requires financial assistance. The reference should be an adult who knows the family (not a
relative or close friend). (Examples of Reference: Social Worker, Clergy, Group Leader, Coach,
Teacher, Doctor).
- If the applicant is a client of Community Services, they can get Community Service to stamp the
application form and no reference would be required. The applicant will be contacted if any
further information is required.
Application Procedure
- The application form must be completed and submitted to the Recreation & Parks Office at least
three weeks prior to the start of the program.
- Late applications may not receive approval in time to start the program.
- Families will be asked if they can contribute toward the cost of the activity.
- Applications are processed on a first come, first serve basis.
- If families have questions about the application form or would like to receive assistance in
completing the form, please contact the PRO Kids Coordinator at the Municipality at 902-275-
3490 or prokids@chester.ca.
- The PRO Kids Coordinator will review all applications to ensure criteria is met and the reference
is checked.
- Applicants should hear the results of their application within 3 weeks of applying.
Funding
- There is no maximum funding limit.
- Applicants can request assistance with registration fees and/or equipment costs at any time of
year but funding will be provided no more than once per season.
- Cheques are made payable directly to the organization and/or the supplier of equipment.
YOUTH SPONSORSHIP GRANT (Policy P-56)
The Youth Sponsorship Grant is intended to assist individuals or teams who have been successful with
their sport or activity and who will be competing at a provincial, national or international event. This grant
helps to support our local athletes and teams at a time when they have experienced a significant
accomplishment and need additional funding in order to participate at a higher level of competition.
Eligibility
- The recipient must reside in the Municipality of the District of Chester.
- The recipient must be age 21 or under and presently attending school, regular or post-secondary,
part-time and/or full-time.
- Persons with disabilities of any age are eligible for funding.
- The recipient must have won their way and/or have been selected to attend a recognized
sanctioned Provincial, National or International level event (this includes Maritime, Atlantic and
East Coast events).
- The applicant must be a non-profit, volunteer organization that acts as the sponsor, or where the
recipient is the applicant, the recipient shall be registered with an organized community group,
recreational or sporting association.
- Cheques shall be made payable to the organization or event.
- Individuals or teams that have been selected to attend an event must demonstrate significant
achievement or have received distinguished recognition in their sport or activity.
Ineligible Activities
- School related trips or activities are not eligible for funding.
- Training, training camps or skill development workshops are not eligible for funding.
Application Procedure
- Applicants must complete the Youth Sponsorship Application form for the event they are
requesting compensation.
- There is no application deadline.
- Applications must include a budget showing expected revenues and expenditures.
- If families have questions about the application form or would like to receive assistance in
completing the form, please contact the Recreation & Parks Director at 902-275-3490 or by email
at chaughn@chester.ca.
- Applications will be reviewed by the Recreation & Parks Committee and a recommendation
made to Municipal Council for final approval.
- Successful applicants are asked to submit a brief report after completion of the event to indicate
outcomes and highlights of the experience.
Funding
- Individuals or teams are eligible for a maximum of $2,000.
- Support will be distributed as widely as possible among the successful applicants.
MUNICIPALITY OF THE DISTRICT OF CHESTER
GRANT APPLICATION FORM
Youth Sponsorship Request
Name of Applicant ______________________________________________________________________
Name of Parent / Guardian_______________________________________________________________
Mailing Address________________________________________________________________________
______________________________________________________ Postal Code___________________
Phone ________________________________________________
Email _________________________________________________
Are you presently attending school? Yes ____ No ____
If yes, Name of School ___________________________________________________________
Grade / Year ______________________________________________________________
What sport / activity are you competing in? ___________________________________________
What is the name of the event in which you are attending? ______________________________________
Did you win to compete ______ OR were you selected to compete ______
Please provide the date and details of when this occurred:
_______________________________________________________________________________________
_______________________________________________________________________________________
_________________________________________________________________________________
At which level are you competing? Provincial ____ National ____ International ____
If your application is approved, we require the following details to process funding:
Make Cheque Payable to: __________________________________________________________
Mail Cheque to: __________________________________________________________________
____________________________________ Postal Code__________________
Please provide dates of the competition and a brief description of what you did to advance to this level:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
BUDGET
Revenue
Fundraising
Personal Contribution
Other
Other
Youth Sponsorship Funding (Requested)
Total $
Expenses
Registration Fees
Travel
Other
Other
Other
Total $
Please Note - Demand for the Youth Sponsorship Funding varies from year to year, as can the amount of
funding available. Applications will be reviewed on a quarterly basis (typically June, September, December
& March).
Applicant Signature _____________________________________________________
Parent / Guardian Signature ______________________________________________
Date _________________________________________________________________