Alberta Association of Agricultural Societies | Farm Safety Grant

Farm Safety Grant – Application

Click here for the program guidelines

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1 Organization Information

2 Contact Information

3 Project Information

4 Budget

5 Submit Application

Organization Information

Agricultural Society Name

Incorporation Number

Address

0 /

Phone Number

Website URL

Facebook

Twitter

Contact Information

Contact Person 1

Name

Title

Phone NumberDaytime

Alternate Contact

Name

Title

Phone NumberDaytime

Project Information

Project DescriptionDescribe your program or project. Include the title or name of the project if applicable.

0 /

Is this project or program part of another event that you already do?

YesNo

Who are your partners on this project?Include the name(s) and phone numbers(s) of any partners outside of your Ag Society that are involved in this project as well as how they are involved.

0 /

PurposeHow does your project or program meet the purpose of this grant program? How does it create awareness or influence behavior change in relation to farm safety?

0 /

Target AudienceWho is the target audience for this project or program?

0 /

Budget

You may fill out the information below or upload a copy of your budget

Fileupload

Upload

Revenue

Admission/Gates/Registration Fees

Interest Income

Cash Donations/Sponsorship

Fundraising(ie 50/50)

Other Grants

AAAS Farm Safety Grant Amount Requested

Total Revenue: $[(field26)+(field27)+(field28)+(field29)+(field30)+(field49)]

Expenses

Advertising/Promotion

Office Supplies

Wages

Facility Rental

Additional Insurance

Volunteer Expenses

Food & Beverage Expenses

Equipment Rental

Trainers and/or Speaker Fees

Take Home Resources, Door Prizes, Promotional Items

Other

Please Specify your Other Expenses

0 /

Total Expenses: $[(field44)+(field43)+(field42)+(field41)+(field40)+(field39)+(field38)+(field37)+(field36)+(field35)+(field32)+(field45)+(field46)+(field47)]

Donations and Volunteer Hours Expected

Donations

Donated or in-kind items and services expected	Approximate hours or value of service
		×

(1)

Volunteer Hours Expected

Declaration

Confirm Totals

Total Expenses: $[(field44)+(field43)+(field42)+(field41)+(field40)+(field39)+(field38)+(field37)+(field36)+(field35)+(field32)+(field45)+(field46)+(field47)]

Total Grant Request: $[field49]

I declare that the information contained in this application is true and accurate. I am a duly authorized
representative according to our bylaws with financial signing authority for this application. I agree to provide a report which outlines how the funds were spent on this project, and which indicates that we complied with all conditions of the grant. I also declare that if a grant is awarded we will use it solely for the purposes outlined in this application.

Signatures From Two Officers of Your Organization is Required

If both officers are not available to sign the online application, you may upload a signed copy of the signature sheet found below.

Download Printable Signature Sheet Here

Upload Signatures

Upload

Officer 1

Officer 1 Name

Title

SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

Date

Officer 2

Officer 2 Name

Title

SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

Date

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Farm Safety Grant – Application

Farm Safety Grant – Application

Total Revenue: $[(field26)+(field27)+(field28)+(field29)+(field30)+(field49)]

Total Expenses: $[(field44)+(field43)+(field42)+(field41)+(field40)+(field39)+(field38)+(field37)+(field36)+(field35)+(field32)+(field45)+(field46)+(field47)]

Total Expenses: $[(field44)+(field43)+(field42)+(field41)+(field40)+(field39)+(field38)+(field37)+(field36)+(field35)+(field32)+(field45)+(field46)+(field47)]

Total Grant Request: $[field49]

Officer 1

Officer 2

Platinum Plus

Platinum