2023 CHIP Grant Report - Operational Funding
Please submit this form by April 26th, 2024 by 11:59 pm

In addition to this form, you must submit:
- Operational Report Declaration
- Financial Statements OR Profit and Loss Statement

Failure to complete this report as agreed upon in the CHIP contract, would result in a recall of allocated funds and a one-year suspension from the CHIP program. As such, additional applications for funding would not be accepted.

In addition to completion of this form, please attach declaration form and financial statement. These can be found at www.londonheritage.ca/chip/.

  • APPLICANT INFORMATION

  • PRIMARY CONTACT

  • - -

  • MOST SENIOR OFFICIAL/SIGNING OFFICER

  • - -
  • Note: If you are a recipient of match funding for a new intern, confirmation of external funding will be required in the Supporting Materials below.
  • If so, please explain how these resources have been used.
  • Include revenue sources including funding received from CHIP.

  • OPTION 1. INTERNSHIP FUNDING

  • WAGES

  • Start and end date of employment period:
    $ per hour:
    Hours per week:
    Number of weeks worked:
    Additional Costs (mandatory employer costs – please provide a breakdown):
    Total Costs:
    Total Funding Received from CHIP:

  • OR

  • Start and end date of employment period:
    $ per hour:
    Hours per week:
    Number of weeks worked:
    Additional Costs (mandatory employer costs – please provide a breakdown):
    Total Costs:
    Total Funding Received from External Funder:
    Total Funding Received from CHIP:

  • OPTION 2. OPERATIONAL FUNDING

  • FUNDING MEASUREMENTS

    Complete the following:
  • Goal:
    Objective:
    Objective:
    Objective:
    Outcome:
    Outcome:
    Outcome:
    Outcome:
    Outcome:
    Consider re-evaluating your original answers and make adjustments around the true result of your targets.
  • Were you able to develop new programs, projects or operations due to this funding support? What were you able to accomplish? How many people did this funding impact?

  • SECTOR STATISTICS

    For the 2022 CHIP funding period, please include the most accurate representation of statistics available for your organization.
  • Total Federal funding:
    Total Provincial funding:
    Total Municipal funding:
    Total Private Sector funding:
    Total Full-time staff:
    Total Part-time staff:
    Total Contract staff:
    Total Full-time staff supported by employment grants:
    Total Part-time staff supported by employment grants:
    Total Contract staff supported by employment grants:
    Total Volunteers:
    Total Volunteer hours:
    Total New volunteers:
    Total number of operating days this year:
    Total number of operating hours this year:
    Total number of collaborations or partnerships that you held this year:
    Total number of school groups and students that you managed this year:
    Total number of community and private events that you managed this year:

  • FINANCIAL STATEMENTS

    Please submit your most recent Financial Statements.
  • If possible, provided your most recent Audited Financial Statements for the year funding has been received, otherwise attach your most recent copy of Financial Statements.

    Please keep in mind there is no CHIP Reconciled Budget for the Operating stream.

  • SUPPORTING MATERIALS

    • If applicable, payroll records for the appropriate timeline of the interns(s) hired through CHIP.
    • If applicable, proof of “match funding” from external revenue source/funding organization
    Please note for Internship - Match Funding you must provide a copy of proof of employee funding from an external revenue source/funding organization, with $ amounts reflected for which CHIP funding has been used to match.
    • Upload a maximum of 5 supporting materials for our files, including brochures, posters, flyers, photos, newspaper clippings, etc. with a brief description of each item. For video file uploads, please upload each file on YouTube and provide the link in the "description field" followed by a brief description (one link per description field). No more than 10 minutes worth of video in total.
  • Up to 150 words
  • Up to 150 words
  • Up to 150 words
  • Up to 150 words
  • Up to 150 words

  • DECLARATION

    Please ensure you fill out, sign and date the Report Declaration provided by LHC prior to upload. No other forms will be accepted. This can be found at www.londonheritage.ca/chip/.

  • If you have any questions, please contact:

    Richa Joy
    Interim Fund Development Officer
    rjoy@london.ca
    519-930-2140 Ext 8455

    London Heritage Council
    201 King Street
    London, ON N6A1C9
    info@londonheritage.ca
    www.londonheritage.ca
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