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Montreal Canadiens Children's Foundation

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Request for donations
Application form

Print the page
Major donor
I want to make a donation
Please fill the fields marked with an asterisk (*).

1. General information

* Name of the organization:
* Date of foundation:

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* Revenue Canada registration number.
Please use the following pattern: XXXXXXXXXRR0001
* How your organization can best be described:







:
* Is your organization a beneficiary of Centraide?


Main contact

* Name:
* Title:
* Phone number:
() -
Fax:
() -
* E-mail:

Organization's address

* Postal Code:
* Street number:
* Street name:
* City:
* Province:
Web Site:
* How did you learn about the Montreal Canadiens Children's Foundation?
* Mission and objectives of the organization
(maximum of 150 words)

* List of events, programs and services:
(please check all applicable choices)












:

Description of your organization's clientele

* Age categories
(please select all applicable choices)






:
* Physical, social and economic conditions
(please select all applicable choices)







:

2. Your organization's proposed project

* Please submit a reference name for your project:
* The Foundation seeks to assist underprivileged children. Does your program cater to this clientele?


* The Montreal Canadiens Children's Foundation's support is primarily aimed at programs that foster healthy lifestyle habits, through physical activities and good nutrition. The Foundation also supports educational projects that encourage the acquisition of new skills, knowledge and competencies.
Does your project embrace these themes?


In which domain does your project fit?



* Please describe your project.
In general, but concise, terms, please describe your project. Tell us what you'd like to do and why. If possible, use an enumeration form (with highlighted points).

* Description of your targeted clientele
(please select all applicable choices)



:
:
:
* How will your project improve the lives of young people? What are the anticipated results?
Tell us, in enumeration form, how your project will benefit the community. What will be the positive results? Please indicate the most important result that you are hoping to achieve. Please be precise.

Please include three measurable indicators that will determine if the project met its desired result.

Please indicate how you will measure your project's impact, and what you are basing your project's results on. Please be precise.

First indicator

Second indicator

Third indicator

3. Proposed project's budget

* How much are you requesting from the Foundation? Specify the amount.
* How will these funds be used?
* What is the total budget for this project?
* How much money have you already raised?
* Will other partners help finance your project?


Please list your main partners and include their contributions.

ConfirmedAmount
1. * $ *
2. * $ *
3. * $ *
* How many remunerated persons will work on this project?
* How many volunteers will work on this project?
Revenues Expenses
Federal subsidy:
*$
Activity material:
*$
Provincial subsidy:
*$
Specialised and/or adapted equipment:
*$
Municipal subsidy:
*$
Registration and /or participation fees:
*$
Beneficiaries' contributions:
*$
Other: :
*$
Private donations:
*$
Other: :
*$
Other: :
*$
Other: :
*$
Other: :
*$
Other: :
*$
Other: :
*$
Other: :
*$
Other: :
*$
Other: :
*$
Total revenues:
$
Total expenses:
$

Confirmed receipt of your request

Before you submit your request, we recommend that you print a copy for your records.

When you are ready to submit your form, click on the Submit your request icon. An email confirming receipt of your request will be sent to you within 30 minutes. We will email you during the processing phase of your request to keep you up to date.

IMPORTANT
Even if you choose to print a copy, your request form MUST be submitted online via the Foundation's Web site.

If you have any questions regarding funding requests, please email Sylvie Nadeau, the Foundation's donations and administration co-ordinator, at snadeau@canadiens.com.


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