Community Readiness and Opportunities Planning (CROP)

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The personal information that you provide in this document is collected under the authority of the Privacy Act for the purpose of responding to this request. This information cannot be disclosed to other persons without your consent except where disclosure would be justified pursuant to one of the paragraphs of subsection 8(2) of the Privacy Act. The information collected is described under the Standard Personal Information Bank, Access to Information and Privacy, PSU 901.

Application Form 2014-2015

PLEASE FILL OUT THIS FORM COMPLETELY OR SUBMIT A SEPARATE DOCUMENT THAT INCLUDES YOUR RESPONSE FOR EACH SECTION OF THIS FORM.

Project Name:

Date of Application:

Organization:

Project Start Date:

Amount Requested:

Be advised that the organizations will not be eligible for funding if: i) the organization is not in good standing; or ii) the organization has any outstanding reporting requirements related to previous CanNor agreements.

PART I - Applicant Contact Information

  1. Applicant Name:
  2. Applicant Title:
  3. Organization Name:
  4. Business Number:
  5. Box/Street:
  6. City/Town:
  7. Province/Territory:
  8. Postal Code:
  9. Contact Name:
  10. Contact Phone Number:
  11. Fax Number:
  12. Contact E-Mail Address:
  13. Applicant Type: First Nation Council, Tribal Council, Corporation or Other

PART II - Community / Applicant Information

A) Proponent Community

B) Predominant Type: First Nation, Inuit

  • First Nation- or Inuit-controlled Corporation, co-operatives, partnerships
  • First Nation- or Inuit-controlled organization association and institutions
  • Business development and economic development organizations
  • Municipal Government
  • Not for profit
  • For profit
  • New
  • Existing
  • First Nation
  • Inuit
  • Métis
  • Individual/Sole Proprietorship
  • Partnership
  • Corporation
  • Joint venture
  • Other (specify)
  • N/A

C) List of Proponent other Communities involved in this project. Please indicate First Nation, Inuit.

D) Where the applicant is acting on behalf of proponent communities (Part II-C) in addition to itself, describe information demonstrating that all communities have given the applicant a mandate to act on their behalf. Provide key documents (letters, Band Council Resolutions, etc) in an annex. Please indicate what documents are provided.D) Business Number:

E) If the proponent is not a First Nation or Tribal Council, describe the legal, ownership and control structures of the organization

PART III - Project Context and Description

A) Applicant Eligibility Assessment

  • Identify basis upon which the applicant is eligible for funding under this program.
  • First Nation and Inuit community/regional governments and Tribal Councils;
  • Organizations, corporations, associations, co-operatives partnerships and institutions controlled by First Nations or Inuit people, except for those with charitable or religious purposes as their main object;
  • Aboriginal business development and economic development organizations or associations that provide business development, financial or economic development services to Aboriginal individuals, Aboriginal businesses or Aboriginal communities.

B) Industry Sector

  • Educational services
  • Health care and social assistance
  • Mining and quarrying
  • Oil and Gas extraction
  • Forestry
  • Arts, entertainment and recreation
  • Agriculture
  • Utilities
  • Other services (except public administration)
  • Professional scientific and technical services
  • Fishing and hunting
  • Construction
  • Manufacturing
  • Waste management and remediation services
  • Transportation and warehousing
  • Accommodation and food services
  • Finance and insurance
  • Management of companies and enterprises
  • Administrative and support
  • Wholesale trade
  • Information and cultural industries
  • Retail trade
  • Real estate and rental and leasing

C) Provide a description of the project

D) Provide a description of the circumstances giving rise to the project

E) Project Components/Key Activities

Activity
Description (Provide detailed information about each activity)
Activity Cost
Completion Date
Output

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

PART IV - Project Budget

A) In the space provided below or on a separate page, indicate all Sources of funds for the project:

Sources
Year One
Year Two
Total

Applicant Contribution

Partner Contribution

CanNor Contribution

Other Federal Funding

Provincial/Territorial Government

Other (Specify)

B) In the space provided below or on a separate page, indicate all Uses of funds for the project:

Professional and technical services

Other personal services

Communications

Conferences, workshops, meetings

Training delivery and trainee costs

Work experience initiatives

Economic Infrastructure

Salaries and Wages

Travel

Overheads

Minor machinery and equipment

Other (Specify)

C) Substantiate all uses of funds (e.g. quotations for contracts, costing methodology, estimates, person days and per diems for services, estimates of travel requirements and costs). Provide key documents in an annex.

D) Substantiate why funds are expected from other sources, describe terms and conditions of the funding (e.g. through commitment letters), and provide contact names and telephone numbers for funds expected from other sources.

E) Describe efforts that have been made to secure funding from other sources to replace CanNor funding.

F) If the project has received previous federal funding, provide information on the amount, source (department or program), purpose, amount and status.

G) If CanNor has funded a previous stage of this project and financial statements have been provided, state when the reports were submitted. If CanNor has funded a previous stage of this project and financial statements have not been provided, provide financial statements for the previous stage of the project in an annex.

PART V - Project Management

A) Summarize, for key personnel, roles responsibilities, level of education, professional qualifications, previous employment/experience, training, position and remuneration. Provide resumes in an annex. Describe the organizational structure.

B) Identify the nature of outside services that will be obtained in connection to this project

PART VI - Project Administration

A) Describe the nature of accounting records that will be required by the organization and the level of expertise that will be required by the accounting personnel.

B) Describe the provisions that will be made to ensure that the records are properly maintained.

C) State the name of the firm or individual that will be appointed as auditor and the extent of any proposed involvement by them in the financial management and control of the organization.

D) Describe the nature of special services to be provided by the auditors and present an estimate of the costs involved.

PART VII - Economic Benefits

A) Identify any First Nation and Inuit communities expected to benefit from the project that were not previously identified as proponents of this application.

B) In the space provided below or on a separate sheet, summarize the benefits of the project in terms of:

  • increased community economic capacity
  • increased employment of community members
  • greater utilization and value of community land and resources
  • contracts and sales for community businesses
  • community government revenues from economic development
  • development of economic or other infrastructure
  • access arrangements for lands and resources beyond community control
  • additional investments in communities
  • better climate and environment for community economic development
  • more and larger community businesses

C) Describe any other economic or non-economic benefits expected to result from this project.

PART VIII - Land Issues (Complete this section if project envisages the use of reserve land)

A) Indicate the land tenure required by the project:

B) Describe the status of acquiring the land tenure, and provide relevant documentation

[ ] Ownership
[ ] Permit
[ ] Lease or rent
[ ] Certificate of Possession or Occupation
[ ] License
[ ] Other – specify

PART IX - Environmental Issues

A) An environmental assessment in relation to the proposed funding may be required where (a) the funding will be used for an undertaking in relation to a physical work such as construction, operation, modification, decommissioning or abandonment, where a physical work has a fixed location, (b) the project is listed in Inclusion List Regulations under the Canadian Environmental Assessment Act. If an environmental assessment is required, provide the following information. If in doubt, contact CanNor's Regional Office.

Environmental Aspect

Characterization of environmental effect of project from the following: (Not applicable, Unknown, Insignificant, Significant)

Description of Environmental Concern, including Cumulative Impacts

Groundwater

Surface water

Air quality

Noise

Land or soil

Flora

Fauna

Habitat

Special places (cultural, traditional, historical, scientific)

Describe proposed actions to mitigate adverse environmental effects. Provide any environmental assessment reports that have been developed.

PART X - Regulatory Issues

A) Describe key regulations and approval requirements that affect the development or operation of the business, describe the status of securing approvals, and outline measures that will address key regulations and approval requirements.

PART XI - Other Significant Information

A) Provide information regarding any possible conflict with Claims Negotiations of other First Nations and Inuit communities within the same geographic area or operation.

B) Provide a pro-forma monthly statement of cash flow for the duration of the proposed activity(ies) based on planned expenditures and commitments of funds from all sources in an annex. If there is a shortage of cash flow for a given period, indicate how it will be financed.

C) Provide other significant and relevant information not provided elsewhere

PART X - Regulatory Issues

A) Describe key regulations and approval requirements that affect the development or operation of the business, describe the status of securing approvals, and outline measures that will address key regulations and approval requirements.

PART XI - Other Significant Information

A) Provide information regarding any possible conflict with Claims Negotiations of other First Nations and Inuit communities within the same geographic area or operation.

B) Provide a pro-forma monthly statement of cash flow for the duration of the proposed activity(ies) based on planned expenditures and commitments of funds from all sources in an annex. If there is a shortage of cash flow for a given period, indicate how it will be financed.

C) Provide other significant and relevant information not provided elsewhere

PART XII - Annexes

A) Indicate documents provided as an annex to this application:

[ ] Background information (e.g. community development plans/strategies, previous studies)

[ ] Project work plan

[ ] Detailed project budget

[ ] Documents substantiating uses of funds (quotations for contracts, costing methodologies, estimates of person days and per diems, estimates of travel requirements and costs)

[ ] Documents substantiating commitments of funds from other sources (eg commitment letters)

[ ] Financial statements for a previous stage of the project if not previously provided

[ ] Resumes of key personnel

[ ] Pro-format monthly statement of cash flow for the duration of the proposed activities

[ ] Detailed community economic benefits from the project

[ ] Documents indicating the applicant has the support of proponent community or communities (e.g. letters, Band Council Resolutions) if the applicant is operating on behalf of one or more communities

[ ] Documents indicating either the acquisition of required land tenures or the status of acquisition (e.g. Band Council Resolution, council letter, draft lease or permit) if a land tenure is required.

[ ] Environmental assessment reports if an environmental assessment is required.

[ ] Documents indicating the willingness of other parties to negotiate, if the project involves negotiations.

[ ] Other (specify)

PART XIII - Signatures and Authorizations

I certify that:

  • the information in this application and its annexes is correct, to the best of my knowledge;
  • appointed representatives of the Minister are authorized to obtain and share with persons or organizations, public or private, any information necessary to complete the assessment of the project outlined;
  • the applicant is in principle prepared to enter into a funding agreement with CanNor and to accept the terms, conditions and other obligations of the funding agreement or funding agreement amend; and
  • I am authorized to sign this application on behalf of the quorum of the First Nation Council if the applicant is a First Nation applicant, or the organization making the application.

Signature:

Name:

Position/Title:

Date Submitted:

Date modified: