Adaptive Sport Club Development Grant Application Form

APPLICATION DEADLINES

Club/Community Organization (if applicable)
The club/community organization must submit the completed application to the respective Provincial Sport Organization (PSO), Multi-Sport Organization (MSO) or District for endorsement by March 22 and/or September 22 annually.

PSO/MSO/District
The PSO/MSO/District must review, endorse and submit the application to the Sask Lotteries Trust Fund (Trust Fund) by April 1 and/or October 1 annually.

It is recommended that Fall/Winter sports apply by the Spring deadline and the Spring/Summer sports apply by the Fall deadline. Applications must be submitted to and approved by the Trust Fund before the start of the program.

ORGANIZATION TYPE

I'm applying on behalf of a:*

Club or Community Organization
Provincial Sport Organization, Multi-Sport Organization or District

CONTACT INFORMATION

Club or Community Organization*

Contact Name*

Position*

Phone*

Club or Community Organization Email*

Website*

PSO/MSO/District*

Contact Name*

Position*

Phone*

PSO/MSO/District Email*

PSO/MSO/District Fiscal Year*

GRANT INFORMATION

What is the grant amount being requested?*

(Maximum of $5,000 per initiative)

Please enter a number from 1 to 5000.

Have you received an Adaptive Sport Club Development Grant for this program in prior years?*

Yes
No

If yes, what year(s)?*

Total Amount Received:*

Have you applied for funding assistance from any other source?*

Yes
No

Please explain your answer.*

PROGRAM INFORMATION

Program Name*

Type of application*

Community Program
Provincial Program

Type of program*

New developmental sport program
Enhancement of existing sport program

Please provide a brief description of the sport program.*

How will the program increase sport opportunities for people with disabilities?*

Please provide a brief description of the sport program.*

How will the existing program be expanded or enhanced to increase sport opportunities for people with disabilities? (Ex. New age group, gender identity group, classification, adaptive sport or geographical location)*

What sport(s) will this program involve?*

Program Start Date*

(dd/mm/yyyy)

Program End Date*

(dd/mm/yyyy)

Number of Weeks*

Program Times*

Location(s)*

Which communities/towns have participants that will benefit from the sport program?*

Indicate the age group(s) your program will be targeting? (check all that apply)*

Under 12
13-18
19-54
55+

Who is your target audience? (check all that apply)*

Athletes with an intellectual disability
Athletes with a physical disability
Athletes who are blind or visually impaired
Athletes who are deaf or hard of hearing
Other: (please explain)

Other*

Will the program be led by a qualified coach or instructor?*

Yes
No

What is the name(s) of the qualified coach or instructor?*

Use the + to add information

Estimated number of athletes involved in the program?*

Estimated number of coaches/instructors involved in the program?*

Estimated number of officials involved in the program?*

Will there be training, certification or skill development opportunities offered to coaches/instructors?*

Yes
No

Will there be training, certification or skill development opportunities offered to officials?*

Yes
No

Will there be training, certification or skill development opportunities offered to volunteers?*

Yes
No

Will you be partnering with any other group, community or organization to offer this program?*

Yes
No

Please list the group, community or organization you will be partnering with.*

How will the program be promoted?*

Will the program incorporate sport medicine and science services? (Ex. sport nutrition, strength and conditioning, mental training, etc.)*

Yes
No

Please explain your answer.*

Approved grant amounts may vary depending upon the number of applications received and the level of funding available. If the full grant amount requested is not approved, how will this impact your sport program?*

Other comments:

SASK LOTTERIES PROMOTION

This grant is made possible by Sask Lotteries, the main fundraiser for more than 12,000 sport, culture and recreation groups in communities across Saskatchewan. Sask Lotteries must be recognized within all communications and promotions developed. The Sask Lotteries logo, brand guidelines, key messages and promotional materials are available at sasklotteries.ca/funding-recognition

How will Sask Lotteries be promoted? (check all that apply)*

* For event announcements, please contact communications@sasksport.ca for specific scripting/messaging.

Signage (posters, banners, etc.)
Print ads
Website
Social media
Event announcements *
Promotional items
Other:

FINANCIAL BUDGET

Please outline all anticipated program revenues and expenses.

Note: Financial documentation (receipts) for the program must be provided at the time of the follow-up report. Please refer to the Follow-up Requirements section of the guidelines for acceptable forms of financial documentation.

Revenues

Revenues	Amount

Use the + to add information

Expenses

Expenses	Amount

Use the + to add information

TOTAL SURPLUS (DEFICIT)

ADDITIONAL INFORMATION

(OPTIONAL)

Please attach any additional program information such as registration forms, brochures or advertisements.

Drop files here or

Max. file size: 32 MB, Max. files: 5.

CLUB/COMMUNITY ORGANIZATION DECLARATION

Is the application being submitted prior to the start date of the sport program or activity?*

Yes
No

Please Note: Retroactive funding is not permitted. Applications must be submitted to and approved by the Sask Lotteries Trust Fund before the start date of the program.

I understand that approved projects and expenses must be within the grant period for which the grant is approved and expenses that take place outside the grant period are not eligible for support.*

Yes
No

I acknowledge that if this application is approved, I will be required to enter into an agreement with the PSO/MSO/District which will detail the terms and conditions of the grant.*

Yes
No

On behalf of our organization, I hereby agree that the terms and conditions outlined in the guidelines will be adhered to and the information presented in this application is correct and true.*

Yes
No

Club or Community Organization Signing Authority Name

Position

DECLARATION INSTRUCTIONS

Club or Community Organization:
Once completed, please send the link to the PSO/MSO/District by clicking on the ‘Club or Community Organization: Send link to PSO/MSO/District’ link at the bottom of the form.

PSO/MSO/District’s Declaration:
Click the ‘PSO/MSO/District Only – Declaration’ button to proceed to the PSO/MSO/District declaration section.

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Adaptive Sport Club Development Grant Application Form

APPLICATION DEADLINES

ORGANIZATION TYPE

CONTACT INFORMATION

GRANT INFORMATION

PROGRAM INFORMATION

SASK LOTTERIES PROMOTION

FINANCIAL BUDGET

ADDITIONAL INFORMATION

CLUB/COMMUNITY ORGANIZATION DECLARATION

DECLARATION INSTRUCTIONS

PSO/MSO/DISTRICT DECLARATION