Form: Application for Grants Over $5,000

Form to apply for grants for over $5,000 from InternetNZ.

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Name of applying organisation:
Legal status of applicant (Limited liability company/trust/incorporated society/group of individuals, etc:
Company/society/trust registration number (Companies Office):
Name of contact person:
Email address:
Physical and postal addresses, other contact info:
Names and contact information for all shareholders/trustees/principals:
Number of fulltime staff employed:
GST registered:
Financial year end balance date:
Purpose of funding:
Aligns to which specific INZ objectives:
Amount of funding sought from INZ:
Total budget of the project:
Proportion of project income anticipated from sponsorship:
Identity of other key sponsors:
What other parties have been approached to assist:
Identify risks for this project:
Measurement for success for project:
Contacts for referees from previous sponsors/funders:
What further information can you provide in support of your application: