Applicant Information

Type of Applicant*

Applicant Information

Applicant Name (organization or individual)*

Registration or Charitable Number (if applicable)

Full Address (street address, city, postal code)*

Contact Person (full name)*

Email*

Phone*

Website (optional)

Request Details

Primary Focus Area*

Children and Youth Dignity and Essential Needs Housing and Living Environments

Project Summary

Explain the need, objectives, beneficiaries, timeline, total budget, etc. (300 words max)

Approximate Number of People Affected (number)*

Exact Project Location (address, neighbourhood)*

Project Start Date (if applicable)

Project End Date (if applicable)

Nature and Amount of Contribution Requested*

Financial Donation (max $1,000) (if checked, specify amount) Donation (products, materials, services) Sponsorship (visibility in exchange for support)

Amount of Financial Donation

Budget and Funding

Total Project Budget ($)*

Other Confirmed Sources of Funding (specify names and amounts)

Follow-Up and Commitment

I agree to provide a brief impact report within six months of the contribution, if the request is accepted, and to send it to the following email address: info@cuisi-n-art.com

Declaration and Consents

I confirm that the information provided in this form is accurate and that I am authorized to submit this request

I authorize Cuisi-n-Art to verify the information provided (registration numbers, references)

I have read and accept the privacy policy and terms of use related to the use of my data

¹ Registered charities:

If your request is accepted, please issue a donation receipt in the name of Cuisi-n-Art.

Send it by email to: info@cuisi-n-art.com or mail it to 480 Ch. Industriel, Gatineau, QC J8R 0J9