Tautoko ā pūtea Sponsorship Application We have sponsorships available for the Mataatua rohe Home Services Sponsorship Application Sponsorship Application Applications are reviewed on a rolling basis; we prioritise individuals, marae, hapū and community organisations who demonstrate how they can meet these goals and align with our values and principles. "*" indicates required fields Step 1 of 2 50% Application Name* First Last Who are you applying on behalf of?* Myself Organisation Group Organisation / Group Name* Phone*Email* How did you hear about us?*Please select...FacebookWebsiteWhanau / FriendNewspaperSearch EngineKaimahiAnother ProviderOtherSpecific area or sponsorship type?* Health & Wellbeing Educational Cultural Sport and Recreation Project / Event Name* Start Date* DD slash MM slash YYYY End Date* DD slash MM slash YYYY Amount requested*Total Project Cost*Amount Contributed*Have you previously applied for funding through TPOOM?* Yes No Do you or your group live in the Mataatua Rohe (Eastern BOP)?* Yes No Have you or your group ever received, or are you currently receiving funding from Te Puna Ora Mataatua?* Yes No If yes, what was the activity / event and what year was the funding approved?*Are there any potential conflicts of interest to be disclosed?* Yes No If yes, please explain conflicts of interest*Terms & ConditionsAgree to Terms & Conditions* By ticking this box you agree to the statement(s) below and can continue submitting the application To all Te Puna Ora o Mataatua media statements, advertising, and promotion surrounding the sponsored activity Te Puna Ora o Mataatua will have the right to use the sponsorship activity in its own promotional work and to using your submitted application material including photos in all Te Puna Ora o Mataatua media That the media team or staff of Te Puna Ora o Mataatua will be invited to participate in the activity at no cost where this is appropriate Where the media team or other staff are unable to attend, photos of the project will be provided by the applicant to Te Puna Ora o Mataatua Is directly relevant to the Mataatua Rohe Is not considered a conflict of interest About the Project / EventPlease provide an overview of the event for which you are seeking support*Please provide a breakdown of what the funds will be used for (quotes to be uploaded further down)*Please explain the benefits that both parties will receive through this sponsorship*Upload GST InvoiceAccepted file types: jpg, pdf, png, Max. file size: 10 MB.Upload Bank Account Verification*Accepted file types: jpg, pdf, png, Max. file size: 10 MB.Upload Supporting Documentation / Quotes* Drop files here or Select files Accepted file types: jpg, pdf, png, Max. file size: 10 MB. AuthorisationTrue & Accurate* I certify the information given in this form is true and accurate Conflicts of interest disclosed* I confirm that any potential conflict of interests or receiving of additional funding from Te Puna Ora o Mataatua have been fully disclosed Failure to disclose* I understand that failure to do so will result in forfeit of funding and discontinuation of any future applications. Signature* Δ