Community Investment Fund Agreement Accountability Form

Due 1 May 2020

Please complete the following accountability form for your Community Investment Fund Agreement. Forms cannot be saved so you will need to complete it in the one sitting.

As reports are due 1 May, the last 2 months of the year will need to be forecast. Please advise if there are any changes from what you reported following its submission.

Please ensure that you have copies of all required supporting documents before completing the form. On submission of your report, you will receive an automated response via email with a copy of your accountability report.

1. Organisation Details

Name of organisation

Name of contact person

Phone number

Email address

2. Funding details

Evidence upload (receipts, invoices, or statements)

Photo verification of what was funded

Funding received (zero GST)

Date funding was received (month/year)

Please provide evidence that explains how your funding was spent. A reminder that Nelson City Council must be specified in your accounts.

3. Reporting outcomes

Referring to your agreement please list the outcomes you were funded to provide

Will you meet these by 30 June 2019?

Yes

If not, why not?

Please summarise what you did and the difference that it made. (200 word limit)

4. Signatory Sign Off

Our organisation has carried out the requirements of the agreement to the best of our ability.

Please tick to confirm*

Full name

Position

Please note that we will be carrying out checks with 10% of funding recipients. This will involve a scheduled meeting with the organisation, with the intention of gaining a better insight into how funding has been spent to achieve outcomes.