Funding Application Form
Indigenous Partnership Fund

* = Required fields

1.0 Applicant Information

Legal Name of Organization *

Street Address *

City *

Province/Territory *

Postal Code (Canada) *

Phone (###-###-####) *

Website (http://www.url.com)

1.1 Primary contact for this application

First Name *

Last Name *

Title (if applicable)

Phone

Email *

Authorized to sign on behalf of the organization / entity:

Yes

Same address as main address provided above:

Yes

(if yes, skip address fields below)

Street Address

City

Province/Territory

Postal Code (Canada)

1.2 Additional person(s) with signing authority (2 maximum)

Person #1

First Name

Last Name

Title (if applicable)

Phone

Same address as main address provided above:

Yes

(if yes, skip address fields below)

Street Address

City

Province/Territory

Postal Code (Canada)

Person #2

First Name

Last Name

Title (if applicable)

Phone

Same address as main address provided above:

Yes

(if yes, skip address fields below)

Street Address

City

Province/Territory

Postal Code (Canada)

1.3 Type of organization

Select one:

First Nations, Inuit, or Métis governments and organizations, Bands, Tribal Council, Indigenous self-government entities, local, regional or national Indigenous organization

Incorporated not-for-profit Indigenous controlled organizations

Incorporated for-profit Indigenous controlled organizations, when the work being performed under the transfer agreement is not-for-profit

Indigenous-controlled unincorporated organizations

Please specify:

Modern treaty signatory and/or self-governing nation

Indigenous rights-holding group

National or regional Indigenous organization

Indigenous women’s organization

Indigenous youth organization

2SLGBTQI+ Indigenous group or organization

Indigenous persons with disabilities organization

Urban Indigenous organization

Other identified Indigenous institution or group (please specify):

Please specify (maximum 2000 characters)

1.4 Incorporation

Is your organization incorporated?

Yes

If yes, please answer the questions below:

At which level of government is your organization incorporated?

Incorporation number

Date of incorporation

1.5 Band registration

Is your organization a registered band?

Yes

If yes, please provide your Band Number:

1.6 Charitable organization

Is your organization registered as a charitable organization with the Canada Revenue Agency?

Yes

If yes, provide the information below:

Registration number

Date of registration

1.7 For Québec organizations only

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

Is your personnel appointed in accordance with the Public Service Act (of Québec - Chapter F-3.1.1)?

Yes

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

If you answer "yes" to any one of the three questions in this section, your organization is required to provide a copy of the Ministerial Order allowing your organization to negotiate and enter into an agreement with Justice Canada either with your completed funding application or before a formal agreement will be offered by Justice Canada. For more information about this requirement, please see: "An Act respecting the Ministère du Conseil exécutif" (chapter M-30) on the Government of Québec’s website.

2.0 Mandate and key activities

What is the mandate of your organization and key activities? (maximum 2000 characters)

2.1 Anticipated timeframe (April 1, 2024 – March 31, 2025)

Start Date

End Date

2.2 Project title

What is the project title?

2.3 Project description

Please briefly describe your project including the objectives, goals and activities to be undertaken to contribute to implementation of the UN Declaration Act and Action Plan. (maximum 2000 words)

2.4 Needs

Describe why your project is needed and how it will address these needs? (maximum 800 words)

2.5 Expertise and experience

What is your organization's expertise and/or experience to undertake this project? Please also list your key accomplishments. (maximum 500 words)

2.6 Target population

Who will directly benefit (target population) from this project?

Children and Youth (0 to 18 years old)

Women

Elders

Persons with disabilities

2SLGBTQI+ persons

Urban Indigenous communities

Entire community

Other groups

Other (specify): (maximum 2000 characters)

2.7 Collaboration

What communities, nations or organizations do you plan to collaborate with in this process? If applicable, please list the partners you anticipate working with and the level and nature of support provided. (maximum 2000 characters)

2.8 Diversity and inclusion

Will your process include diverse participants (e.g. women, youth, Elders, 2SLGBTQI+, persons with disabilities)? If yes, please describe the steps you plan to take to ensure their full participation: (maximum 300 words)

2.9 Activities

List the activities that you will undertake to complete this project. Include the timeframe, outputs and outcomes for each activity. (Note: this table is optional. Feel free to use your own workplan template if you wish).

Activity #1

Activity

Timeframe

Outputs (products and/or services) (maximum 2000 characters)

Outcomes (results) and measures of success in achieving goals. (maximum 2000 characters)

Activity #2

Activity

Timeframe

Outputs (products and/or services) (maximum 2000 characters)

Outcomes (results) and measures of success in achieving goals. (maximum 2000 characters)

Activity #3

Activity

Timeframe

Outputs (products and/or services) (maximum 2000 characters)

Outcomes (results) and measures of success in achieving goals. (maximum 2000 characters)

Activity #4

Activity

Timeframe

Outputs (products and/or services) (maximum 2000 characters)

Outcomes (results) and measures of success in achieving goals. (maximum 2000 characters)

Activity #5

Activity

Timeframe

Outputs (products and/or services) (maximum 2000 characters)

Outcomes (results) and measures of success in achieving goals. (maximum 2000 characters)

To submit additional activities, send details by email to pb-dgp@justice.gc.ca. Include the legal name of your organization and primary contact information for your application.

2.10 Metrics

How will you measure the impact or success of your project (select all that apply)?

Evaluation (including third party or in-house evaluation)

Survey

Pre- and post-participant questionnaires

Data collection against key performance indicators

Other (specify)

Other (specify): (maximum 2000 characters)

2.11 Budget

Current project start and end dates (April 1, 2024 – March 31, 2025)

Start Date

End Date

Justice Canada Cash Contributions

Contribution #1 - Salary (and benefits)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #2 - Travel (and benefits)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #3 - Rental/Leasing (for meetings and conference facilities)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #4 - Professional fees

Expense Description (maximum 2000 characters)

Expense amount

Contribution #5 - Consultants (including legal counsel)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #6 - Honoraria

Expense Description (maximum 2000 characters)

Expense amount

Contribution #7 - Office Equipment, Furniture, Supplies and materials

Expense Description (maximum 2000 characters)

Expense amount

Contribution #8 - Other (please specify)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #9 - Administrative (no more than 15% of total budget)

Expense Description (maximum 2000 characters)

Expense amount

Total

Expense amount

Other Cash Contributions (please list other sources of revenue for this project only)

Other source of revenue for this project only #1:

Other source of revenue for this project only #2:

Contribution #1 - Salary (and benefits)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #2 - Travel (and benefits)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #3 - Professional fees

Expense Description (maximum 2000 characters)

Expense amount

Contribution #4 - Consultants (including legal counsel)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #5 - Office Equipment, Furniture, Supplies and materials

Expense Description (maximum 2000 characters)

Expense amount

Contribution #6 - Other (please specify)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #7 - Administrative (no more than 15% of total budget)

Expense Description (maximum 2000 characters)

Expense amount

Total

Expense amount

In-Kind Contributions for this project only (In-kind is the amount of funding that is given in goods and/or services rather than money)

Contribution #1 - Salary (and benefits)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #2 - Travel (and benefits)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #3 - Professional fees

Expense Description (maximum 2000 characters)

Expense amount

Contribution #4 - Consultants (including legal counsel)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #5 - Office Equipment, Furniture, Supplies and materials

Expense Description (maximum 2000 characters)

Expense amount

Contribution #6 - Other (please specify)

Expense Description (maximum 2000 characters)

Expense amount

Contribution #7 - Administrative (no more than 15% of total budget)

Expense Description (maximum 2000 characters)

Expense amount

Total

Expense amount

2.12 Federal audit

In the last 5 years, has the federal government audited your organization? If yes, please provide a copy of the audit report(s).

Yes

2.13 GST/HST rebate

Does your organization receive a GST/HST rebate from the federal government?

Yes

If yes, please provide the percentage:

2.14 Additional information

If applicable, provide any additional information about this project that you think is relevant and that we should know. (maximum 300 words)

Conditions

In the event that your funding application is successful, you will be required to provide banking information in order to permit electronic payments.

Departmental funding may be used only for the purposes specified in this application. Once the Department has agreed to grant financial assistance, no major change can be made to the project without departmental approval (in each case, the Department shall determine what constitutes a major change). Funds not used for these purposes must be returned to the Department.

The organization bears full responsibility for its debts. The Department will not consider any request for assistance in settling debts. The organization must agree to comply with all provincial, territorial and federal legislation.

The Department's financial contribution must be explicitly acknowledged and must be mentioned in publications funded by the Department. A typical form of acknowledgement is: “We acknowledge the financial support of the Department of Justice Canada”.

With regard to the project or programming for which funding is requested, the organization shall agree to comply with the spirit and intent of the Official Languages Act by implementing the appropriate linguistic measures.

By signing this application, (the applicant) authorizes the Department of Justice Canada to disclose any information received in this application within the Department and the Government of Canada or to outside entities for the following purposes: to reach a decision on this application, to administer and monitor the implementation of the project or programming, or to evaluate the results of the project or programming after project completion. This disclosure of any information received in this application may also be used to reach a decision on any other application of the applicant for funding under any other departmental program.

In the event of an access to information request regarding the present funding application or any relevant information about the organization in the Department's possession, the information provided to the Department will be entirely disclosed, with the exception of personal information, which will be treated in accordance with the Privacy Act.

Any person lobbying on the recipient's behalf must be registered under the federal Lobbyists Registration Act.

Declarations

I declare that:

the information in this application is accurate and complete;
the application is made on behalf of the organization named, whose name appears in knowledge and consent;
if financial assistance is granted, the organization shall undertake to provide financial reports on results pursuant to the requirements of the Department of Justice Canada;
if financial assistance is provided, the organization shall agree to an assessment programming pursuant to the requirements of the Department of Justice Canada;
no public servant or holder of public office, past or present, which is in breach of the Values and Ethics Code for the Public Sector or the Conflict of Interest Act shall derive a direct benefit from the requested funding;
this organization has not paid or agreed to pay, directly or indirectly, and agrees that it shall not pay, directly or indirectly, any contingency fees for the solicitation, negotiation or acquisition of funding for the purposes of this application.

Applicant *

Name of person with signing authority *

I agree to the conditions and declarations *

Yes

Date *

Date modified:: 2023-12-01

Funding Application Form Indigenous Partnership Fund

1.0 Applicant Information

1.1 Primary contact for this application

1.2 Additional person(s) with signing authority (2 maximum)

Person #1

Person #2

1.3 Type of organization

1.4 Incorporation

1.5 Band registration

1.6 Charitable organization

1.7 For Québec organizations only

2.0 Mandate and key activities

2.1 Anticipated timeframe (April 1, 2024 – March 31, 2025)

2.2 Project title

2.3 Project description

2.4 Needs

2.5 Expertise and experience

2.6 Target population

2.7 Collaboration

2.8 Diversity and inclusion

2.9 Activities

Activity #1

Activity #2

Activity #3

Activity #4

Activity #5

2.10 Metrics

2.11 Budget

Justice Canada Cash Contributions

Contribution #1 - Salary (and benefits)

Contribution #2 - Travel (and benefits)

Contribution #3 - Rental/Leasing (for meetings and conference facilities)

Contribution #4 - Professional fees

Contribution #5 - Consultants (including legal counsel)

Contribution #6 - Honoraria

Contribution #7 - Office Equipment, Furniture, Supplies and materials

Contribution #8 - Other (please specify)

Contribution #9 - Administrative (no more than 15% of total budget)

Total

Other Cash Contributions (please list other sources of revenue for this project only)

Contribution #1 - Salary (and benefits)

Contribution #2 - Travel (and benefits)

Contribution #3 - Professional fees

Contribution #4 - Consultants (including legal counsel)

Contribution #5 - Office Equipment, Furniture, Supplies and materials

Contribution #6 - Other (please specify)

Contribution #7 - Administrative (no more than 15% of total budget)

Total

In-Kind Contributions for this project only (In-kind is the amount of funding that is given in goods and/or services rather than money)

Contribution #1 - Salary (and benefits)

Contribution #2 - Travel (and benefits)

Contribution #3 - Professional fees

Contribution #4 - Consultants (including legal counsel)

Contribution #5 - Office Equipment, Furniture, Supplies and materials

Contribution #6 - Other (please specify)

Contribution #7 - Administrative (no more than 15% of total budget)

Total

2.12 Federal audit

2.13 GST/HST rebate

2.14 Additional information

Funding Application Form
Indigenous Partnership Fund