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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:


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