Funding Application General Information Form

A. Applicant identification (please print)

  • Incorporated Name
  • Previous name of association or organization, if applicable
  • Scope of organization's activities
    • Local
    • Municipal
    • Provincial/Territorial
    • Regional
    • National
    • International

LEGAL STATUS

  • Incorporated
    • Yes
    • No
    • Federal
    • Provincial/Territorial
    • Registration no. - Date of registration
    • In process - Date applied
  • Date and place of incorporation
  • Registered with Canada Revenue Agency as a charitable organization
    • Yes/No
    • Registration no. - Date of registration
    • In process - Date applied

B. Contact Information (please print)

  • Name of contact for official correspondence
  • Title
  • Mr./ Mrs./ Ms./ Other (specify)
  • Preferred language of communication - English/French
  • Telephone no. - ext.
  • Facsimile no.

ADDRESS

  • Street
  • City
  • Province/Territory
  • Postal code
  • Web site address
  • E-mail address

Mailing address (if different)

  • Apt./Suite
  • Street/POB
  • City
  • Province/Territory
  • Postal code

C. Affirmation

I affirm that the information in this application is accurate and complete and the project proposal, including plans and budgets, are fairly presented. I agree that once funding is provided, any change to the project proposal will require prior approval of the Department. I agree to publicly acknowledge funding and assistance by the Department, in accordance with the terms of the funding agreement. I also agree to submit a final report, and where required, financial accounting for evaluation of the activity funded by the Department. I understand that the information provided in this application may be accessible under the Access to Information Act. I also agree to respect the spirit and intent of the various acts governing the programs of the Department of Canadian Heritage.

  • Authorized Signature
  • Name and title (please print)
  • Date