Funding Application

If you would like to submit an application for funding assistance to the Trustees, please complete the Request for Funding Application Form below.

Name of Applicant/Organisation

Key Contact Person

Key Contact Person Phone Number (no spaces)

Key Contact Person Email

Mailing Address

Background of Programme/Product/Service

Development of Programme/Product/Service

Utilisation of Funds

Total Amount Requested

How will you report on progress/outcome?

How will the health and wellbeing of New Zealand Communities benefit from this Programme/Product/Service?

Have you sought funding from any other organisation?

Are you aware of any conflict of interest?

Are you aware of any ethical issues pertaining to this application?

Your Name

Dated:

Empowering leadership in General Practice through resourcing concepts, ideas and talent.

Funding Application