Provider Languages Fund application

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Organisation details

Formal or registered name of your organisation

Type of entity

Registration or incorporated number (if applicable)

New Zealand Business Number (if applicable)

Registered address

Postal address if different to registered address

GST number (if registered)

Primary contact

Name

Role in organisation

Contact number

Email

Secondary contact

Name

Role in organisation

Contact number

Email

What language group will your initiative target and support?

Select all areas that apply to the initiative.

Craft or object

Dance or performing arts

Digital learning

Visual arts

Music

Literature

Oratory

Other

Define your target audience and how will you reach them.

Provide a detailed description of the initiative.

Describe how your initiative involves language planning and development. This includes how you plan to maintain and sustain its outcomes in the medium to long term.

Describe how your proposal will contribute to achieving the Ministry of Pacific People’s Lalanga Fou Goal: Thriving Pacific languages, cultures, and identities.

Describe how your proposal contributes to achieving the fund objectives.

Describe how the initiative will be delivered.

Describe how the initiative will be managed.

Describe the initiative’s desired outcomes and how they will be measured.

Describe any risks and issues and how they will be managed. Such as how the initiative could run if it’s not fully funded and how components of the project could be prioritized.

Capability

Describe your organisation and any prior experience working with Pacific communities.

Capacity

Describe what resources you have to deliver your financial capability initiative such as people, training materials, facilities etc.

References

Provide details about your organisation's previous successful projects.

Provide contact details for two independent referees for your organisation.

Name

Contact number

Email

Relationship to your organisation

Name

Contact number

Email

Relationship to your organisation

Upload a copy of certification of registration/or registration number with Charities or Companies Office.

Upload detailed budget breakdown of the initiative.

Upload a verified copy of your bank statement, a pre-printed bank deposit slip or a screenshot of your online bank statement clearly showing your account name and number.

Vulnerable Children Act 2014

If your application includes providing services to children, you must provide a copy of your Child Protection Policy.

Children’s services are defined as:

Services to one or more children
Services to adults in respect of one or more children
Services provided to adults living in households that include one or more children and that:
1. Do or may affect significantly any one or more aspects of the well-being of those children; and
2. Maybe prescribed/defined by the Governor-General by Order in Council.

Upload a copy of your child protection policy if applicable.

Declaration

In digitally signing this Declaration, I:

Confirm the information contained in the proposal is true and accurate.
Confirm I have read and understood my rights regarding the Privacy Act 1993 as set out in the guidance document.
Confirm this proposal complies with the objectives of my organisation as contained in the Organisation’s Constitution or Trust Deed.
Understand that there is no guarantee that my organisation will be successful in securing an investment from the Ministry for Pacific Peoples.
Agree that the Ministry for Pacific Peoples may collect information about my organisation from any third party in respect of this proposal.
Agree that, if the proposal is successful, the name of my organisation, purpose of investment and the amount of the Ministry for Pacific Peoples’ investment will be available as part of the Ministry for Pacific Peoples’ accountability for public funds.
Agree that the information provided in this document can be used by the Ministry for Pacific Peoples for statistical purposes and/or policy development.
Agree that, if successful, my organisation may be required, along with the targeted beneficiaries of the proposed project, to participate in an evaluation of the proposal.
Accept full accountability and responsibility for all requirements associated with the completion of the proposal.

Name

Designation

Yes, I agree to the above and digitally sign this form.

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