Community Group Funding Request FormCommunity Group Funding Request – 2017 Town of Tillsonburg Budget
Those community groups requesting funds from the Town in 2017 will be requested to present
their request to Council at the meeting on December 1, 2016 between 4pm and 7pm. You will have
15 minutes to present and answer questions from Council. All times for those presentations will be
coordinated through the Clerk and the Treasurer.
Please fill out the form below and return to Donna Wilson (DEWilson@tillsonburg.ca) and Janelle
Costantino (JCostantino@tillsonburg.ca) by Tuesday, November 15, 2016.
If there is additional information you wish to communicate to Council, but is not included in the
form below, please feel free to include under a separate document.
*****
Community Group Name Click here to enter text.
Summary of purpose/mandate of your group
Click here to enter text.
Financial statements for 2014 and 2015 attached? Yes No N/A
2017 budget request amount: $
Why do you require funding and what will the funds will be used for?
If request is part of a group funding effort, please include the make-up of the funding source.
(i.e. Donations, grants from other community groups, Town grant, etc)
Click here to enter text.
Has the Town granted funds to your group in the past 3 years? If yes, please indicate the
amount(s) and uses.
Year Amount Uses
2016 $ $
2015 $ $
2014 $ $
Group member who will be presenting at the December 1, 2016 meeting:
Click here to enter text.
Will you be using a powerpoint presentation? Yes No
Preferred time range
*Please note, this time is not guaranteed. The Town recognizes that the presenter may have other
commitments during the scheduled meeting time. We will try our best to schedule accordingly and
will contact you with the allocated time slot.
4:00pm – 4:15pm
4:15pm – 4:30pm
4:30pm – 4:45pm
4:45pm – 5:00pm
5:00pm – 5:15pm
5:15pm – 5:30pm
5:30pm – 5:45pm
5:45pm – 6:00pm
6:00pm – 6:15pm
6:15pm – 6:30pm
6:30pm – 6:45pm
6:45pm – 7:00pm
No preference
Have you included additional information for Council’s consideration? Yes No