On Air SHARE ON: You are one of dozens of amazing organizations who provide such important service to the Timmins community. As you well know, that work often goes unnoticed, under staffed and with limited funding. We believe if we share the stories of need and the great work you do, this community will respond with help. It could come in the form of volunteers, resources or even funding. So let’s tell your story and let everyone know why this work makes such a difference in our community. Moose FM is proud to partner with our friends at Newmont Porcupine to establish the Community Voice Fund. Each month a local group will receive a FREE ONE MONTH ADVERTISING PROGRAM. We’ll use this to tell our community just how important your work is to all of us. So, we hope you can take advantage of this opportunity to reach thousands of people all over Timmins. Please fill out the required information below for review by the MooseFM/Newmont Porcupine Community Voice Fund Committee. Failure to provide complete information will result in a delayed response. Your organization may be required to complete a Community Contribution Post Initiative Survey, should you be the beneficiary of this program. Community Voice Fund Application Form Name of organization/group:* Please select one of the following that best describes your organization:*Government EntityOrganized Sports TeamRegistered CharitySchoolNon-Profit OrganizationOtherCharity NumberIf your organization is a registered charity, please provide number. Other OrganizationIf your organization is described as 'Other', please provide more details. What is the mandate of your organization?*How will Newmont Porcupine/Moose FM be recognized for contributing to your event/initiative?*How many people will benefit directly from this event/initiative?* Less than 25 25-100 +100 Does the organization enhance the development of local skills and/or business capacity?* Yes, directly Indirectly No Does the organization aim to promote diversity and/or support underrepresented groups?* Yes, directly Indirectly No What beneficiary groups will be impacted from this event/initiative?*MenWomenChildren 0-17Youth 18-25Students (primary)Students (secondary)Students (tertiary)SeniorsIndigenousPeople in remote areasLocal community membersSociety at largeVulnerable GroupHomeless peoplePeople affected by physical health/diseasePeople affected by disabilitiesPeople without access to basic servicesPeople affected by addiction disordersPeople affected by mental health issuesArtisansEntrepreneursOtherDetails for 'Other' beneficiary groups who will be impacted from this event/initiative:Has Newmont Porcupine provided support to your organization in the past?* Yes No If yes, provide details:Please provide any additional comments to support your request (you may also attach supporting documentation):File Upload Drop files here or Select files Max. file size: 500 MB. Key Contact Person Details | First and Last Name* Email Address* Phone Number* Recipient Details | Name of Organization* Mailing Address*Street Name / PO Box City / Province Postal CodeCAPTCHANameThis field is for validation purposes and should be left unchanged.