Adaptive Sport Equipment 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?*

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

Yes
No

Please explain your answer.*

EQUIPMENT INFORMATION

What sport(s) will the equipment be used for?*

Will this equipment be used in an Equipment Loan Program?*

Yes
No

When do you expect to order the equipment?*

When do you expect to receive the equipment?*

Any additional information regarding the equipment you would like to purchase:

ADAPTIVE SPORT EQUIPMENT QUOTATION INFORMATION

(List each different type of equipment, in priority order)

Quotes*

Technical Name of Equipment	Name of Equipment Supplier	Quoted cost per unit ($)	No. of units requested	Total Cost

Use the + to add information

Please upload two quotes from different equipment suppliers for each type of equipment.*

Drop files here or

Max. file size: 32 MB.

Have you attached two quotes for each type of equipment?*

Yes
No

Please provide an explanation detailing why two supplier quotes were not submitted.*

Do you anticipate any additional shipping/duty costs that aren't included in the quote(s)?*

Yes
No

What is the anticipated shipping/duty cost?*

PROGRAM INFORMATION

Program Name*

Type of application*

Community Program
Provincial Program

Please provide a brief description of the sport program the equipment will be used for.*

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

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 equipment/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

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 the purchase of equipment and the sport program?*

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:

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 purchasing the sport equipment?

Yes
No

Please Note: Retroactive funding is not permitted. Applications must be submitted to and approved by the Sask Lotteries Trust Fund before the equipment is purchased.

I understand that approved equipment must be purchased within the grant period for which the grant is approved and equipment that is purchased outside the grant period is 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 Equipment Grant Application Form

APPLICATION DEADLINES

ORGANIZATION TYPE

CONTACT INFORMATION

GRANT INFORMATION

EQUIPMENT INFORMATION

ADAPTIVE SPORT EQUIPMENT QUOTATION INFORMATION

PROGRAM INFORMATION

SASK LOTTERIES PROMOTION

FINANCIAL BUDGET

ADDITIONAL INFORMATION

CLUB/COMMUNITY ORGANIZATION DECLARATION

DECLARATION INSTRUCTIONS

PSO/MSO/DISTRICT DECLARATION