VAN TEL/SAFEWAY
CREDIT UNION Legacy
Fund
FUNDING APPLICATION
Name of the Project:
Legal Name of Organization:
Address:
Postal Code:
Phone Number:
Fax Number:
Date Organization Established:
Revenue Canada Charitable BN Number:
Application Contact Person 1:
Position
Phone Number(s): day and evening
Application Contact Person 2:
Position
Phone Number(s): day and evening
*Name(s) of Bond Affiliates: (This is a critical component of the grant review process)
How did you hear about us?
* List all employees and retirees of Telus, Safeway, Kruger Products, Pacific Newspaper Group,
Summit Logistics. or one of their affiliate companies/unions and former Van Tel/Safeway Credit
Union members – who are members or are volunteers of your organization.
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VAN TEL/SAFEWAY
CREDIT UNION Legacy
Fund
Project/Program Description
Start date:
Project Duration:
Grant Request Amount:
Date Funding Needed:
Target Group: (circle those applicable to project)
Youth
Environment
Crime Prevention
Community Enhancement
Purpose of the Project (outline goals)
How does this project relate to the overall purpose and priorities of your organization?
How will your organization evaluate the success of the project?
If this is an ongoing project/program, how will its viability be maintained in the long term?
Have you approached other groups for support? If Yes - list and indicate status of your request.
If No, are you planning to approach other groups? List who and when
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VAN TEL/SAFEWAY
CREDIT UNION Legacy
Fund
Tell us a little about your organization. This is important as it gives us a clear sense of what the
organization is about. You could include the Mission Statement, mandate, goals and operating
principles.
Attach copies of the following:

income and expense budget for project (maximum 2 pages )

most recent audited financial statements

current annual report
I certify that the above information is accurate:
Signature
Title
Date
Forward completed application package to:
Van Tel/Safeway Credit Union Legacy Fund
c/o
Vancity Community Foundation
PO Box 2120 STN Terminal
Vancouver, BC V6B 5R8
Phone: (604) 877-7241
Fax: (604) 709-6909
Email: vcf@vancity.com
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