Aboriginal Peoples' Program

General Application Form

IMPORTANT

  1. Complete all sections, sign and date the form.
  2. Send the form and the project proposal to the Department of Canadian Heritage.
  3. Once completed, this form must not be transmitted electronically to the department in order to ensure confidentiality of your personal/private information.

Part A - Applicant Information

Organization

  • Name in Full (required)
  • Previous Name(s) of Organization (required)
  • Scope of activities (required)
    • Local
    • Municipal
    • Provincial/Territorial
    • Regional
    • National
    • International

Legal Status (required)

  • Incorporated - Yes/No
  • Federal
  • Provincial/Territorial
  • Corporate registration Number
  • In process - Date applied YYYY-MM-DD
  • Registered with Canada Revenue Agency as a charitable organization - Yes/No
  • Corporate Registration Number
  • In process - Date applied YYYY-MM-DD

Contact Person's Name (required)

  • Mr.
  • Mrs.
  • Ms.
  • Other (specify)
  • First Name (required)
  • Family Name (required)
  • Title (required)
  • Office Telephone Number (required)
  • Residence Telephone Number (optional)
  • Fax (optional)
  • E-Mail (optional)

Individual

  • Mr.
  • Mrs.
  • Ms.
  • Other (specify)
  • First Name (required)
  • Family Name (required)
  • Canadian Citizen or Permanent Resident/Landed Immigrant - Yes/No

Applicant's Address

  • Street (required)
  • City (required)
  • Province/Territory (required)
  • Postal Code (required)
  • Mailing Address (if different)
  • Street (required)
  • City (required)
  • Province/Territory (required)
  • Postal Code (required)
  • Telephone Number (required)
  • Fax (optional)
  • E-Mail (optional)
  • Web site (optional)
  • Date YYYY-MM-DD (optional)
  • In which official language do you wish to communicate?(required) - English/French

Part B - Project Summary Information

  • Main type of activity that describes your project (required)
  • Project Title (required)
  • Project Description (required)
  • Proposed Start Date YYYY-MM-DD (required)
  • End Date YYYY-MM-DD (required)
  • Total Cost for Project ($) (required)
  • Amount requested from the Department of Canadian Heritage ($) (required)
  • Have you also applied to other Federal Departments or other programs of the Department of Canadian Heritage? (required) - Yes/No
  • If yes, please specify (optional)

Part C - Affirmation

I affirm that the information in this application is accurate and complete, and the project proposal, including plans and budgets are fairly represented. 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, where appropriate. 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 Canadian Multiculturalism Act, the Official Languages Act and the Canadian Charter of Rights and Freedom and other human rights legislation.

By signing this application, I authorize the Department of Canadian Heritage to disclose any information received in this application within Canadian Heritage 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 and this program 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 PCH program.

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 information provided to the Department will be treated in accordance with the Access to Information Act and the Privacy Act. Where funding is approved, however, 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.

Signing Authority

  • Authorized Signature (required)
  • Name and Title (please print) (required)
  • Date YYYY-MM-DD(required)