Application

Definitions used within this application:

The "Foundation" is The Liz Soper Foundation of Care.
The "Recipient" is the potential awardee of funds from The Foundation.
"The Applicant" is the person completing this form.

Instructions: Please complete all fields and provide as much information as possible.

Application Criteria: Please tick to confirm

The Recipient is a permanent resident of New Zealand, or a citizen of New Zealand and

The Recipient lives in New Zealand

Details of the (potential) Recipient:

Please provide the legal names of the recipient

First Name

Last Name

Recipient's Address

Please provide the recipients home address

Recipient's Date of Birth

Please provide the recipients Date of Birth

YYYY

Recipient's Mobile Number

Please provide the recipients Mobile Number (if applicable)

Recipient's Email

Please provide an email address for the recipients (if applicable)

Description of recipients Impairment/Disability

Please provide a brief description of your (the recipient's) impairment / disability

EXTRA-CARE-ICULAR EXPERIENCE - please provide detailed information about the experience you would like to have.

What is the enriching experience you would like to do?

Please provide detailed information about the experience

Are others applying for funding to have this experience also?

Yes

How will this experience enrich your life?

Please let us know why this experience is important to you. Why have you not previously been able to have this experience?

How would the support of The Foundation assist you to have this experience?

When would you like to have this experience?

Note: all experiences must be completed within 6 months of the funding being awarded.

BUDGET BREAKDOWN - Please provide a detailed breakdown of the costs involved. These costs should be as accurate as possible. Only include costs that are applicable to the experience being applied for.

Please provide an overview of the experience, who might join you and what costs you will incur:

Note: if this is to be an experience shared with others please only apply for the proportion of funding applicable for this recipient.

What is the total cost of this experience for the recipient? (a maximum $1000 will be awarded)

What will the TAXI/TRANSPORT costs be?

Taxi/Transport

What will the CARE & SUPPORT costs be?

Care & Support

What will the ACCOMODATION costs be?

Accommodation

What will the ENTRY/TICKETS costs be?

Entry Fees/Tickets

What will the FOOD/MEAL costs be?

Meals

What OTHER costs will be incurred? Please itemise each additional cost using the 4 spaces below.

Other cost - please provide a brief description

Amount

Other cost - please provide a brief description

Amount

Other cost - please provide a brief description

Amount

Other cost - please provide a brief description

Amount

APPLICATION SUPPORTING PERSON - please provide details of one person (other than the applicant or immediate family member) who can verify and support this application.

Supporting person's name

First Name

Last Name

Supporting person's mobile number

Supporting person's email address

Supporting person's relationship to the recipient

APPLICANT'S DETAILS - if this form is being filled out on behalf of a recipient please provide the applicants details here.

Details of the person (the applicant) filling in this application (if different from above, all fields are mandatory):

First Name

Last Name

Please provide the home address of the applicant

Applicant's Home Address

Please provide the home mobile number of the applicant

Applicant's Mobile Number

Please provide the email address of the applicant

Applicant’s Email Address

10. Applicant’s Acceptance of the Terms and Conditions: Please tick to confirm

Terms and Conditions

I have read and understood the terms and conditions.

THE LIZ SOPER FOUNDATION OF CARE ENRICHING LIFE EXPERIENCE AWARDS

Terms and Conditions

PURPOSE
To enable individuals living with complex needs to enjoy recreational opportunities and enriching life experiences (of their choice) that are usually out of reach due to the complex needs of the individual and financial restrictions.

REGULATIONS
A number of awards, each not exceeding $1000, shall be offered twice per calendar year.

Applicants may apply for awards up to twice per year. The total funds awarded will not exceed $2000 per Recipient in one calendar year.

The Recipient of an award may or may not be the applicant.
Recipients of an award must be:
1. New Zealand Citizens or Permanent Residents, residing in New Zealand.
2. Persons with disabilities who are in need of care and support so they can participate in extracurricular activities.
In making these awards, the selection committee shall give consideration to:
1. The potential recipient’s need for financial assistance.
2. The potential recipient’s history of previous applications.
3. The potential recipient’s ability to undertake the activity within six months of receiving the award.
Applicants will be notified of their application status no later than one month after closing dates.
The Liz Soper Foundation of Care Awards will be paid in one installment within one month of confirmation of the award.
Except for in exceptional circumstances, funds awarded must only be used for the activity applied for.
If the recipient cannot complete the activity stated on the application form within six months of receiving the award, an extension may be sought detailing the reasons for the request. Extension will be at the Board’s discretion. If a request for extension is not approved, all monies must be returned to The Liz Soper Foundation of Care.
Successful applicants/recipients will be required to provide receipts verifying awarded funds were used for the experience stated on the application form. Any awarded funds that are not spent on the approved activity will need to be reimbursed to The Liz Soper Foundation of Care within 10 working days.
Each recipient of a Liz Soper Foundation of Care Award (or their nominated support person) is required to submit photographs and supporting words within two weeks of completion of the activity.

APPLICATIONS AND ENQUIRIES
Enquiries to: foundationofcare@creativeabilities.co.nz

Completed applications can be submitted:

Online www.creativeabilities.co.nz/our-foundation

On submission of your application you will view on screen an acknowledgment that we have received your application. Applications are not reviewed until after the closing date. You will be informed of the outcome of your application within 14 working days of the closing date. All correspondence should be to foundationofcare@creativeabilities.co.nz

All Closing dates for the current funding rounds are published on www.creativeabilities.co.nz/our-foundation