Fee for Service Grant Application

Fee for Service Grant Application

Following the Community Grants Council Policy No. 105 [PDF - 239 KB], this application form is for Non-profit Organizations who are applying for a Fee for Service grant. The City of Fort St. John may contact you to request additional information, or clarification, to support your application. To ensure your application is considered, please complete and return the application with all required documentation by December 31 (unless otherwise specified). 

Alternatively, print and submit the Fee for Service Grant Application [PDF - 207 KB] in-person at City Hall.

Eligibility Criteria

Fee for Service Grant funding is provided by the City of Fort St. John, under an agreement, to assist local non-profit organizations with the delivery of services to the community that the City would otherwise deliver as the service falls within the realm of a municipal service. The fee for service grant represents the City’s contribution towards the group. The term Fee for Service does not imply that the City’s contribution is intended to be a 100% contribution.

Grant applications must be consistent with the City of Fort St. John's aims, objectives, and standards and must not conflict with any City policies.

Once the application is submitted, staff will prepare a report to Council to be included on a Regular Council meeting agenda. Organizations may be required to present to Council at a Committee of the Whole meeting. Staff will prepare a Fee for Service agreement for up to three years. The organization and the City of Fort St. John will sign this agreement.

 

Section 1 - Organization Information

Organization Name:

CRA/Society Act/Charity Registration Number:

Contact Person:

Phone Number:

Address of Organization:

Mailing Address (if different than above): (optional)

Section 2 - Supporting Documentation

Ensure you upload all required supporting documentation and check off the attached documents in the list below.

Supporting Documents Checklist

• Constitution, Bylaws and Society/Charity certification (if not previously provided or if changes have occurred)
• Current list of board members
• Number of employees, their titles, and number of hours paid per year (full time and part time)
• Previous years’ meeting minutes and annual general meeting minutes, (including manager’s report, if applicable)
• Detailed proposed budget for the current year, listing revenue/expenses and all other grants and donations
• Audited financial statements for the previous fiscal year
• Statement identifying the amount of reserved funds, if any, and the purpose of those funds
• Identification of the name and position of any individuals who receive payment from the fee for service funds, (salaries, honorariums or contracts) together with the amount of compensation each receives

Upload documents here. Please note that the provided documents will be made public on a Council agenda.

Section 3 - Use of Funds

Annual grant amount being requested:

How will the City of Fort St. John and its contribution be recognized by your organization?   

Section 4 - Details of Services

What services will be provided, and how will those services align with the City of Fort St. John’s Official Community Plan and Strategic Plan?

Number of Fort St. John residents served annually by your organization: 

Describe how your organization would utilize the grant funds and how it would benefit the community:

If Fee for Service funding is not available, how would your organization provide the services indicated above and what aspect of those services would be most significantly impacted?

What other community support or sponsorship exists for your organization? 

If Fee for Service funds are provided to your organization, what metrics will your organization track and report to highlight the outcomes or impacts of the Fee for Service?

Section 5 - Declaration by Authorized Signatory

I hereby certify that I have read the City of Fort St. John Community Grants Policy No. 105 (linked above), that the application complies with its requirements, and that the information contained in the application is complete and correct.

I hereby agree to indemnify and save harmless the City of Fort St. John and its employees against all claims, liabilities, judgments, costs and expenses of whatsoever kind which may occur against the City and its employees in consequence of and incidental to, the granting of this exemption, if issued. I further agree to conform to all requirements of the applicable bylaw and all other statutes and all other bylaws in force in the City of Fort St. John.

IF THERE IS A CHANGE IN THE STATUS OF YOUR ORGANIZATION THE CITY OF FORT ST. JOHN MUST BE NOTIFIED.

Name:

Title:

Date:

By clicking the submit button below, you are confirming that the information you have provided is true and correct.

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The City of Fort St. John is committed to protecting your privacy. Any personal information you provide to us is collected pursuant to 26(c) and 26(e) of the Freedom of Information and Protection of Privacy Act for the purpose of administering City services.

Should you have any questions about the collection of this personal information please contact the Corporate Officer.