2019-2020 Expression of Interest Form

Word version available to print

Organization Information

(as shown on the Certificate of Incorporation/Status/Registration)

(If operating under a different name, please identify)


Applicant Type

Check all that apply


How long has your organization been in operation?

Describe your organization's mandate, governance structure, primary business activity or service.
Include information about whether or not you have a parent or subsidiary organization and your relationship to these businesses/organizations.

Project Information

Note: Projects are not to begin prior to funding approval. Any costs incurred prior to the project approval date will NOT be eligible for reimbursement under the terms of the Funding Agreement.

What is the anticipated date that project activities will be completed and that proposed deliverables and outcomes will be met?

Describe your project in simple terms. Primarily, answer the questions of:

  • what do you intend to do
  • how you intend to do it
  • who will be involved in the project
  • [maximum 1,000 words]

Describe the outcomes or expected results of the project – how do the results relate to the priorities identified in the EOI Guidelines? Specify who will benefit and how. Examples of economic benefits include:

  • wealth generation
  • job creation and increase to participation rates
  • new product development and/or increase in export potential
  • reducing economic leakage
  • sector/market development/expansion
  • enhanced community economic development capacity in Indigenous communities

This section should answer the following questions as appropriate:

  • Why is the project significant at this point in time?
  • What gap, need or opportunity is your project meeting?
  • What work has already led up to this project?
  • What community or local consultation has occurred that demonstrates support for the project?
  • What analysis or feasibility work has already been completed?

List the names of the partners / organizations and describe their respective contribution to the project.

Provide the organization's name, nature of their involvement.

Work Plan

Please list the project activities in a logical sequence, including timelines and descriptions where needed. Activities should be specific, measurable, realistic and relevant to the project objectives and demonstrate how the project outcome(s) will be achieved.

Project Activity Description Project Activity Completion Date Outputs / Outcomes

Budget

Budget - Projected sources of funds
Funding Partners Total Budget Year 1 (2019/20) Year 2 (2020/21) Percentage
CanNor        
Applicant        
Territorial Government        
Other Fedederal Government Department (specify)
 
       
Additional funders please name
 
       
Total        
Budget - Uses of funds
Costs Total Project Budget Total CanNor Request CanNor Request Year 1 (2019/20) CanNor Request Year 2 (2020/21)
         
         
         
         
         
Total        
*If the proposed project spans more than two fiscal years please use a separate excel spreadsheet to provide budget details

Authorization

Notice to Applicants - Privacy Act Statement

The information collected in your EOI will be used, and may be disclosed, for the purposes of assessing the merits of your application. As part of the assessment process, the information may be shared with external consultants, review committee members, officials in other departments, federal, provincial and/or territorial governments or Members of Parliament.

It may also be used and/or disclosed for policy analysis, research, and/or evaluation purposes. In order to conduct these activities, various sources of information under the custody and control of the Canadian Northern Economic Development Agency (CanNor) may be linked. However, these additional uses and/or disclosures of information will not impact your project.

In the event that your EOI contains personal information, the personal information will be administered in accordance with the Privacy Act. This EOI is also subject to the Access to Information Act (ATIA). The ATIA provides every person with a right of access to information under the control of the department, subject to a limited set of exemptions. Instructions for obtaining access to this information are outlined in the government publication entitled Info Source.

Read & Agreed

Signature & Authorization: This section is to be completed by a representative of the applicant duly authorized to make this declaration in submission of a funding application to the Canadian Northern Economic Development Agency.

 
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