NEW ZEALAND RED CROSS 2011 EARTHQUAKE - COMMISSION VERSION 1. AS AT 30.01.2013
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NEW ZEALAND RED CROSS
2011 EARTHQUAKE
COMMISSION VERSION 1. AS AT 30.01.2013
CHRISTCHURCH SCHOOLCHILDREN’S GRANT:
APPLICATION FORM
SECTION A – GRANT INFORMATION:
New Zealand Red Cross is partnering with schools to help the children and young people of greater Christchurch to
take positive steps ahead as Christchurch rebuilds its infrastructure, communities and homes.
The purpose of this grant is to:
• To ameliorate earthquake-related challenges and needs amongst Christchurch children and young people, which
may be impacting on health, wellbeing and educational outcomes.
• To foster resilience and positivity amongst children and young people; to ensure they are well-placed to contribute to
rebuilding a strong and vibrant Christchurch over the coming years.
More information on grant eligibility, terms, amount, reporting, and application process are provided in the Additional
Information for Schools document. Please refer to this as you fill out the application form.
Eligibility
To be eligible to distribute funding to students through this Red Cross grant:
• Your school must be registered with the Ministry of Education
• Your school cannot be classed as an Early Childhood Education Provider or a tertiary education or training provider.
• Your school must be located within the Waimakariri, Christchurch City or Selwyn Territorial Authorities.
• Students at your school must have need for additional assistance with earthquake-related needs.
• Private schools are not eligible through the main grant mechanism but can apply under the special circumstances section.
The grant is available to support school students from Year 1 to Year 15.
The New Zealand Red Cross Earthquake Appeal fund was established through the generosity of the New Zealand
public and overseas donors to assist with earthquake relief and recovery. Please do not apply for this grant if your
students do not require additional assistance with earthquake-related needs.
Terms of grant
If your application is approved you will be sent a letter of agreement that states the details and terms and conditions of
your grant. The letter of agreement and application form must be signed by both the school principal and chairperson
of the school Board of Trustees. In signing and returning the letter of agreement your school will enter into a contract
with New Zealand Red Cross and commit to terms and conditions that will include:
• Spending grant funding according to purpose of the grant as outlined above.
• Spending grant funding within the categories and amounts and on the activities specified in the letter of agreement.
• Spending all grant funds within a two year period or returning any unspent funds.
• Complying with any request from New Zealand Red Cross for repayment of funds used for purposes other than
those provided for in the terms of the grant.
• Complying with auditing requirements.
VERSION 1. AS AT 30.01.2013 1/13• Providing reporting to New Zealand Red Cross in three stages throughout the grant term. More information on
reporting requirements is provided in section 5 of the Additional Information for Schools.
This grant can only be used to provide resources and assistance that are directly related to earthquake-related needs.
It cannot be used for operational or capital costs such as teacher salaries or purchasing electronic equipment or other
school equipment. More details are provided in Section 3 of the Additional Information for Schools.
Red Cross has the right to approve and decline applications (in whole or in part) at its discretion.
Schools cannot apply for grant funding retrospectively for activities or resources that have already been provided.
Grant funds will be provided to schools in three installments; more information is provided in section C:2 and D:3
of this form.
Publicity of grant
In applying for this grant you are agreeing that where possible, your school will communicate to parents and the wider
school community when programmes and assistance are being provided through Red Cross funding. This helps to
ensure that the community and donating public are aware of how the appeal fund is being spent.
In applying for this grant you are also agreeing that you may be contacted by Red Cross regarding opportunities to
engage with media about the grant and for information that could be used in Red Cross communications.
Funding amount
Grant funding is determined per individual school, according to school roll and on a tier system that is based on
school decile. The three tiers are as follows:
Tier Amount per student (NZ$)
Tier One: Decile One, Two and Three schools $240
Tier Two: Decile Four, Five, Six and Seven schools $120
Tier Three: Decile Eight, Nine and Ten schools $60
The maximum standard grant that your school is eligible for will equate to your school roll, multiplied by the dollar
value of the tier within which your school sits.
A discretionary mechanism is included within the grant process and exceptional needs will be considered by Red Cross
on a case by case basis through the Special Circumstances application form. Private schools may also apply through
this mechanism. Refer to Section 4 of the Additional Information for Schools for more details.
Categories for spending
The grant is to be spent on activities and resources that address the earthquake-related needs of students within six
categories:
1. Assisting with earthquake-related individual hardship
2. Earthquake-related psychosocial supports
3. Encouraging coping and resilience
4. Supporting new entrants and school leavers
5. Providing wellbeing focused events and activities
6. Other – as recommended by specialist support staff or agencies
The grant cannot be spent on general school materials and equipment, general staffing costs, capital costs or
operational costs that are not covered in the above categories.
Please refer to Section 3 of the grant guidelines document for details on what the grant can and cannot be spent on.
VERSION 1. AS AT 30.01.2013 2/13SECTION B – SCHOOL DETAILS
Please fill out the fields below. The form is designed to be filled in electronically. This application must be returned to
New Zealand Red Cross by 26th April 2013. Please email to the Grant Manager at cscgrant@redcross.org.nz
B:1 School Name:
B:2 Address
Physical: Street:
Suburb: City:
Postal: Street:
Suburb: City:
B:3 School Type: (Please Tick)
Full Primary (Year 1-8) Contributing (Year 1-6) Intermediate (Year 7&8)
Secondary (Year 7-15) Secondary (Year 9-15) Teen Parent Unit Special School
B:4 School Authority
State (Integrated and Not Integrated Private
B:5 Territorial Authority
Christchurch City Waimakariri District Selwyn District
B:6 Principal
Name:
Mobile Phone: Landline:
Email Address:
Postal Address:
B:7 Board of Trustees Chairperson
Name:
Mobile Phone: Landline:
Email Address:
Postal Address:
VERSION 1. AS AT 30.01.2013 3/13B:8 What are the main earthquake-related needs of your students?
Please describe:
B:9 Grant rate
Please fill out the table below to determine the maximum grant amount that the students of your school may be eligible
to apply for. Please note this is not final and may be subject to revision by New Zealand Red Cross.
1. Please provide the total number of students enrolled at your school (Year 1-15) according to
the March 1st roll return information that your school provides to the Ministry of Education Roll:
(please also provide a copy of this roll information).
2. Please provide the decile of your school. Decile:
3. To calculate the maximum grant amount that your school can apply for, multiple your roll by the
Grant maximum: $
funding rate eligible to your decile rating (shown under “Funding amount” above)
B:10 Application Type:
Standard grant Special Circumstances grant
See Section 4 of the Additional Information for Schools for more information on Standard and Special Circumstances grants.
SECTION C – STANDARD GRANT
FILL OUT THIS SECTION IF YOU ARE MAKING A STANDARD GRANT APPLICATION, OTHERWISE PROCEED TO
SECTION D
C:1 Standard grant application: how the grant would be spent
Within the maximum amount you have calculated above, please show the resources/activities for which your school
wishes to apply for funding to assist with the earthquake-related needs of students at your school, specifying: type of
each activity/resource to be provided, number of students to be supported through each measure, a brief paragraph
on why it is needed, the timeframe within which the spending will occur, and (if applicable) who will provide the
resource - school staff or name of provider.
The amount that you apply for in this standard grant application must include GST (if any) and cannot exceed the
maximum grant amount figure calculated above in section B:9.
Please type as much in each field as you need to describe what you are applying for and why.
VERSION 1. AS AT 30.01.2013 4/13Addressing individual hardship (uniforms, stationery, camp fees, other)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
Psychosocial supports (counselling, lower level mental health concerns)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
VERSION 1. AS AT 30.01.2013 5/13Encouraging coping and resilience (life skills programmes etc)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
Supporting new entrants and school leavers (e.g. parenting programmes, career guidance)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
VERSION 1. AS AT 30.01.2013 6/13Wellbeing focused events and activities
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
Other – recommended by specialist support staff or agencies
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
TOTAL COST $NZ
VERSION 1. AS AT 30.01.2013 7/13C:2 Schedule of payments
The Grant will be paid in three installments across the two year grant term. If your school wishes to spend the grant
over a shorter timeframe, it can choose an alternative grant term of one year or six months. The dates for payment,
reporting and spending of the grant will be stipulated in the letter of agreement.
Please indicate the grant term your school wishes to apply for below:
Please Tick Grant Term Payment dates Reporting requirements
50% of total grant amount upon signing of grant
First progress report to be received by Red
agreement
Cross no later than 31 December 2013
25% of total grant amount following receipt and
Second progress report to be received
acceptance of first progress Report from school.
by Red Cross no later than 26
2 Years Such payment is expected to be in January 2014.
September 2014
25% of total grant amount following receipt
Final completion report (Report Three) to
and acceptance of second progress report
be received by Red Cross no later than
from school. Such payment is expected to be in
30 days after end of grant term
October 2014.
1 year Payment and reporting dates to be confirmed by Red Cross
6 months Payment and reporting dates to be confirmed by Red Cross
C:3 Declaration (Standard grant application)
In applying for this grant we agree to the Terms and Conditions set out on this application form. We declare that
the information provided above is correct. We understand that this application may be declined if any of the above
information is not correct. We grant permission for New Zealand Red Cross to contact local authorities and/or other
relevant government or non-government organisations for the purpose of considering this application. We have complied
with the Privacy Act in disclosing any personal information to you and to the extent that you have collected any other
personal information from us, we also understand that the Privacy Act 1993 entitles us to have access to and if necessary
request correction of the information.
Principal Date:
Name: Signature:
Chairperson of school Board of Trustees Date:
Name: Signature:
VERSION 1. AS AT 30.01.2013 8/13SECTION D – SPECIAL CIRCUMSTANCES GRANT APPLICATION FORM (OPTIONAL)
FILL OUT THIS SECTION IF YOU ARE MAKING A SPECIAL CIRCUMSTANCES GRANT APPLICATION
If the students of your school are experiencing a high level of negative earthquake-related impacts that are beyond the
resources available through the standard Christchurch Schoolchildren’s Grant (and beyond the resources of the school
and families), the school may apply for additional funding for the cost of resources required by making a special
circumstances application instead of a standard grant application.
If private schools have students who are experiencing a high level of negative impact from the earthquakes and
significantly more resources are required to address this than are available through school and family resources, they
can apply for a special circumstances grant. Schools should fill out the application form below and provide supporting
information as indicated.
Red Cross and the Grant Reference Group will consider special circumstances applications and make a decision at its
discretion. Reasons that will be considered in this process are listed below. All special circumstances applications will
be assessed after applications have closed and payment will therefore not be made until Term Two.
Please refer to Section 5 of the Additional Information for Schools for information on eligibility for a Special
Circumstances grant and the information that needs to be provided in this application.
D:1 Why your school is applying for a Special Circumstances grant
Please detail the reasons your school requires special circumstances funding, as per the eligibility criteria listed in
Section 4 of the Additional Information for Schools and provide any evidence and documentation that supports your
application.
Why does the standard grant amount does not cover the earthquake-related needs of your students:
Provide details around these earthquake-related needs (e.g. roll change data, number of children requiring
specialist support or hardship-related assistance, behavioural issues). Attach any relevant information.
D:2 Special Circumstances application: how the grant would be spent
Within the maximum amount you have calculated in section B:9, please show the resources/activities for which your
school wishes to apply for funding to assist with the earthquake-related needs of students at your school, specifying:
type of each activity/resource to be provided, number of students to be supported through each measure, a brief
paragraph on why it is needed, and the timeframe within which the spending will occur.
Please type as much in each field as you need to describe what you are applying for and why.
VERSION 1. AS AT 30.01.2013 9/13Addressing individual hardship (uniforms, stationery, camp fees, other)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
Psychosocial supports (counselling, lower level mental health concerns)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
VERSION 1. AS AT 30.01.2013 10/13Encouraging coping and resilience (life skills programmes etc)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
Supporting new entrants and school leavers (e.g. parenting programmes, career guidance)
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
VERSION 1. AS AT 30.01.2013 11/13Wellbeing focused events and activities
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
Other – recommended by specialist support staff or agencies
Number of Activity Expected Provider/
Brief description Cost ($NZ) Why this is needed
students period Personnel
1.
2.
3.
4.
5.
TOTAL COST $NZ
VERSION 1. AS AT 30.01.2013 12/13D:3 Schedule of payments
The Grant will be paid in three installments across the two year grant term. If your school wishes to spend the grant
over a shorter timeframe, it can choose an alternative grant term of one year or six months. The dates for payment,
reporting and spending of the grant will be stipulated in the final letter of agreement.
Please indicate the grant term your school wishes to apply for below:
Please Tick Grant Term Payment dates Reporting requirements
50% of total grant amount upon signing of grant
First progress report to be received by Red
agreement
Cross no later than 31 December 2013
25% of total grant amount following receipt and
Second progress report to be received
acceptance of first progress Report from school.
by Red Cross no later than 26
2 Years Such payment is expected to be in January 2014.
September 2014
25% of total grant amount following receipt
Final completion report (Report Three) to
and acceptance of second progress report
be received by Red Cross no later than
from school. Such payment is expected to be in
30 days after end of grant term
October 2014.
1 year Payment and reporting dates to be confirmed by Red Cross
6 months Payment and reporting dates to be confirmed by Red Cross
D:4 Declaration (Special Circumstances grant application)
In applying for this grant we agree to the Terms and Conditions set out on this application form. We declare that
the information provided above is correct. We understand that this application may be declined if any of the above
information is not correct. We grant permission for New Zealand Red Cross to contact local authorities and/or other
relevant government or non-government organisations for the purpose of considering this application. We have complied
with the Privacy Act in disclosing any personal information to you and to the extent that you have collected any other
personal information from us, we also understand that the Privacy Act 1993 entitles us to have access to and if necessary
request correction of the information.
Principal Date:
Name: Signature:
Chairperson of school Board of Trustees Date:
Name: Signature:
VERSION 1. AS AT 30.01.2013 13/13You can also read
