On-line Responsive Grant Program Application Form

Organization Information

Organization Name:
Street Address:
City:
Province:
Postal Code:
Organization Website:
Charitable tax number:
Society registration number:
Name and contact information of staff person submitting application
First Name:
Last Name:
Title:
Telephone Number:
Fax Number:
Email Address:

Overview of your organization

What is the Primary Purpose or Mission of your Organization?
Who does your organization serve? Please mark any that apply.
Women Youth First Nations
Seniors Families Disabled
Adults Immigrant/Refugee Other
What special barriers do your clients face? Please mark any that apply.
Mental Health Addictions Long term Homeless
Episodically Homeless Eviction Assault/Abuse
Geographic area served: Your organization must be located within City of Surrey boundaries
Please describe your organizations programs and services. In 300 words or less, tell us about your core activities
What is your organization's annual budget: Please include your most recent budget
How many staff are employed by your organization? Full time: Part time:

Description of Project

Responsive grants are slightly different from our ongoing regular grant cycle. Our funding priorities for the Responsive Granting Program are as follows:

  1. Address key priorities along the continuum of needs related to homelessness and access to housing, including:
    a) Lack of emergency shelter beds, in particular for youth, aboriginal adults, and adults.
    b) Lack of transitional housing units - for adult men and women, women leaving the sex trade, youth and culturally appropriate/specific housing.
    c) Lack of supportive housing units for persons with mental health and other issues such as concurrent disorders (mental illness and addiction).
    d) Lack of homelessness prevention services.
    e) Lack of affordable housing.
    f) Capacity building and coordination.
    g) Other emerging needs that support the goals and objectives of the Surrey Homelessness and Housing Fund.
  2. Support Surrey projects that serve Surrey residents.
  3. Demonstrates financial viability and the potential for long-term sustainability.
  4. Demonstrates collaboration and thorough consultation with stakeholders.
  5. Leverages additional funding from government, business and/or foundations.
Please indicate the name or title of your project:
Proposed Start Date:
Type of Project:
Please see our list of key funding priorities
Project Description: Please tell us about what you will be doing (i.e.: activities) or what need will be met by your project
Project goals and objectives: Please tell us what you would like to achieve in the long and short term
How does this project address Homelessness in Surrey? Please select all that apply.
Shelter Beds Public Education Services
Homelessness Prevention Long term supportive housing Affordable Housing
Transitional Housing Units Short Term Supportive Housing Other
What partnerships, if any, have you already established related to this project? Include other funding partners here but also (if applicable) include donations of goods and services, volunteer hours, and in-kind donors.

Budget and Use of Funds
Please provide a preliminary project budget that outlines all expected income and expenses. Income: Expenses
How much are you asking the Surrey Homelessness & Housing Fund to contribute to this project?  



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