STEP 1.  TELL US ABOUT YOU

This section asks for information about your organization, its activities and main focus.

1) In which language do you want to communicate?

English French

2) If you are an individual applying for funding, please complete this part and go to question 7:

Title:   

Mr.   Ms.   Mrs. Miss Other: _______________________

Name: ________________________

Street address: __________________

Telephone: _____________________

Fax: __________________________

E-mail: ________________________

If you are an organization or a government body applying for funding, please complete this part:

Name: ________________________

Street address: __________________

Mailing address (if different from primary address): _______________________

Telephone: ____________________

Fax: _________________________

E-mail: _______________________

Website address:________________

Contact person:

Title : Mr. Ms. Mrs. Miss Other: ________________________

Name: ________________________

Telephone: _____________________

Position: _______________________

3 a)  Is your organization incorporated?  

Yes ¹ Federal ¹ Provincial/Territorial ¹

No

b) Date your organization was started (if not incorporated): ________________________

c) Date your organization was incorporated: ___________________________________

4) Your organization is a/an (check one):

5) Describe the primary work of your organization including your mission and objectives:
(For example:  What do you do on a day-to-day basis?  What is your mandate? What programs and services does your organization provide?  Whom do you serve?  Who actually uses your services?) ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

6) Your organization is active at which level(s)?

7) Describe the expertise, skills, interest and experience that qualify you or your organization to undertake this project, and your previous experience with such issues.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

8 a) Have you ever received funding from the Department of Justice Canada?
Yes – Please provide following information: No

b)   Is the current funding application for a continuation/next phase of one of these previously funded projects? Yes No

c)   On projects previously funded by the Department, was a final report submitted? Yes No – Why? __________________

9) FOR QUEBEC ORGANIZATIONS ONLY

1. Are the majority of your members from the Québec public sector, that is, appointed by the Government of Québec, a minister, a government agency, a municipal body, a school board or another public agency?
   Yes No
2. Is your personnel appointed in accordance with the Public Service Act (of Québec) (chapter F-3.1.1)?
   Yes No
3. Is more than half of your financing derived from Québec public funds, that is from the consolidated revenue fund, a government agency, a municipal body, a school body or another public agency?
   Yes No
4. If you have answered “yes” to one of the above, you must enclose a copy of the Order in Council allowing your organization to negotiate and enter into an agreement with the Department of Justice Canada.
   Enclosed

STEP 2.  TELL US ABOUT YOUR PROJECT

The purpose of this section is to provide details about the project:  What is the main issue?  What do you plan to do, when, and how?  How will you monitor the progress of the project?  How will you know your project is a success?  Please refer to the funding guide for additional important information.

10) Project title: ____________________________

11) Project summary:
The project summary provides a brief explanation of what the project is.  It should describe the activities, who will be affected by the activities and why you want to undertake the project (i.e. what do you want to change).
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

12) Project timeframe: Start dates should be at least 4-6 months after the application deadline to allow time to review and to make funding decisions. The government fiscal year begins April 1 and ends on March 31 of the following year.  Project funds must be spent in the fiscal year for which they were allocated.

Start date: __________________

End date:  __________________

13) Describe your Project Team:

14) Describe your project by addressing the following points:

1. The issue or needs your project would address.  (How do you know there is a need for this project?  Describe what is happening in your community and why it is important to carry out this project. What is the specific justice issue, need, problem in your community?  What are the specific factors underlying the justice issue this project will try to address?)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
   
2. The interest in your community for this project; the partnerships and other linkages indicating support for this project. (Please include endorsements, letters of support and agreements from relevant individuals or organizations to indicate your organizations qualifications to undertake this project and to indicate community support.  Also, for Child-centred Family Justice Fund applications only, please include a letter of support/endorsement of the project from the relevant provincial government department.) (Explain how you know that your community supports this project idea?  Where did you go for information, feedback, suggestions when developing your project?  How were members of the priority group/area involved?)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
   
3. The innovative nature of this project. (How does your project focus on justice issues in new and/or different ways?)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
   
4. The project objectives. (The objectives must be results-based, must be measurable and achievable, should identify what you expect to achieve by the end of the project and should link to the mandate and priorities of the Department of Justice Canada and the objectives of the Fund under which you are applying.)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
   
5. The reach of the project. (Identify the priority groups or the specific social or community groups for whom the project is directed.)
   
   
   Children (0 to under 12 years old) 
   Youth (12 to under 18 years old) 
   Aboriginal peoples
   Women
   Community at large 
   Northern communities
   Ethnocultural or visible minority groups  
   Official language minority groups
   Gay, lesbian, bisexual and/or transgendered persons and/or communities
   Homeless persons
   Persons with disabilities
   Seniors
   Youth at risk
   Victims
   Justice related professionals
   Other professional groups
   Governments (provincial/territorial/federal)
   Other (please specify) __________________
   
   
6. How the project demonstrates sensitivity to diversity and gender equality issues. (Your proposal should show how you would address the needs and experiences of participants/beneficiaries who come from different social and cultural groups, equity groups and diverse communities.)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
7. How the project demonstrates sensitivity to the needs of official language minority communities. (Your proposal should indicate how you would address the needs and experiences of these communities.)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
   
8. The anticipated results of the project. (For each project objective that you have identified above, identify what results are expected because of your project’s activities.)
   ____________________________________________________________________
   
   ____________________________________________________________________
   
   ____________________________________________________________________
   
9. A description of the project partners: (Explain the nature of the partnerships by providing a description of the different activities that each partner will undertake.)

   PARTNERSHIPS: (Identify each of your partners and explain the nature of each partnership):
   Provide the name and contact information for each of your partners:	Identify if your partnerships are on-going or project specific:	Describe the involvement of the partners in this project:

10. The work plan and project design (Activities)  (Include activities and how each activity will support the project objectives, tasks for each activity, time frames, human and financial resources for each activity.)
    ____________________________________________________________________
    
    ____________________________________________________________________
    
    ____________________________________________________________________
    
11. The project deliverables and dates for submission (Outputs) (List all products, goods or services you expect to produce or deliver as part of your project. Often these deliverables take the form of progress/interim reports, training sessions, manuals or publications and final report. For interim reports and final reports, indicate anticipated submission dates.  If you receive funding from the Department, you will be required to submit a Project Summary Report which will be provided to you.)
    ____________________________________________________________________
    
    ____________________________________________________________________
    
    ____________________________________________________________________
    
12. The communication plan(Include the objectives of your communication /dissemination plan, the priority groups that will be reached and methods of communications that you will use to reach them.)
    ____________________________________________________________________
    
    ____________________________________________________________________
    
    ____________________________________________________________________
    

15) Include an evaluation framework.  (Include who will be responsible for monitoring and evaluation, the timetable, the reporting arrangements you have with your partners and how you will identify success and risk factors.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

STEP 3.  DESCRIBE HOW THE MONEY WILL BE USED

16) Please provide a detailed budget for the project.
Indicate the budget for this project, including all revenues (financial and in-kind from ALL sources) and all expenses (financial and in-kind) by fiscal year (April 1 to March 31). 

17) Indicate your organization’s GST/HST rebate (percentage) from Canada Revenue Agency. _____________ %

STEP 4.  SIGN TO COMPLETE THE APPLICATION

Conditions

Departmental funding may be used only for the purposes specified in this application. Once the Department has agreed to provide financial assistance, no substantial change to the project shall be made without the consent of the Department, and it shall be at the discretion of the Department to determine what constitutes substantial change in each case. Any funding not used for these purposes must be returned to the Department.

The organization is wholly responsible for its own debts. The Department will not consider any application to pay debts.  If any part of this funding is used to pay salaries or honoraria, federal and provincial laws concerning salaries and source deductions must be applied (e.g. deductions for income tax, employment insurance, etc.).

Public acknowledgement of funding provided by the Department is expected. Publications should clearly acknowledge the Department's assistance.

The organization agrees to respect and apply the spirit and, if applicable, the letter of the Canadian Human Rights Act and of the Official Languages Act.

In the event of an access to information request regarding the present funding application or any other information about the organization in the Department's possession, the organization will be consulted before any confidential information is disclosed. Under the Access to Information Act, there is provision for exemption from disclosure of personal information subject to the Privacy Act, and of confidential financial or business information.

The designation PROTECTED (when completed) ensures that this information receives enhanced protection. When funding is approved, the amount of funding, the purpose for which the funds were granted and the name of the organization receiving the funding are considered public information.

I declare that

• the information in this application is accurate and complete;
• the application is made on behalf of the organization named on page one (1)with its full knowledge and consent;
• if financial assistance is provided, the organization will submit financial statements and activity reports as required by the Department of Justice Canada,
• If financial assistance is provided, the organization will submit to an evaluation of the project funded, as required by the Department of Justice Canada.

Organization: ______________________________

Name of Person with Signing Authority:___________

Position: __________________________________

Signature: _________________________________

Date: ____________________________________