33. Project title: (Maximum of 90 characters including spaces)
Project address is the same as Mailing address.
35. Project address (Including suite, unit, apt#):
36. Project address line 2:
Newfoundland and Labrador
Prince Edward Island
39. Postal Code:
40. Short Project Description. Provide a summary of the rehabilitation, renovation, repair or expansion work being planned. (Maximum of 500 characters including spaces) *
41. Detailed Project Description. Clearly outline the objective of this project, provide explicit details of the rehabilitation, renovation, repair or expansion work being planned, and identify any project risks and mitigation strategies. (Maximum of 4000 characters including spaces) *
42. Provide the rationale for the project. Clearly outline the importance of this project to your respective community and how this project will benefit the community. (Maximum of 4000 characters including spaces) *
43a. Community Infrastructure Type. Please select one of the following:
43b. If "Other" non-recreational community infrastructure facility was selected, specify type: (Maximum of 100 characters including spaces)
44a. If non-recreational infrastructure was selected in Question 43a, explain how the facility is used for recreational purposes. (Maximum of 1000 characters including spaces) *
49b. If yes, explain how you intend to have the project complete by the Fall of 2017. (Maximum of 1000 characters including spaces) *
50b. If yes, explain how your project will contribute to the celebration of Canada's 150th. (Maximum of 1000 characters including spaces) *
51b. If yes, describe how the project activities will benefit Francophones. (Maximum of 1500 characters including spaces) *
51d. If yes, describe how the project will have a significant impact on Indigenous communities. (e.g., Will Indigenous Peoples be the primary users of the facility? Is the applicant an entity owned or operated by Indigenous Peoples? Does the applicant have a mandate to assist or deliver services to Indigenous Peoples?). (Maximum of 1000 characters including spaces) *
51f. If yes, describe how the activities will advance a clean growth economy (e.g., demonstration and/or installation of clean, green and/or enivironmentally sustainable technologies). (Maximum of 1000 characters including spaces) *
Authorized Official of the Applicant Organization Acknowledgements
The application form must be submitted by a member of your organization with signing power/authority to enter into a legal agreement. This person may be different than the Primary Contact person.
On behalf of the Applicant Organization, I hereby acknowledge and agree that:
This application does not constitute a commitment from Western Economic Diversification Canada (WD) for financial assistance.
I have read the Canada 150 Community Infrastructure Program Applicant Guide and Instructions, including the mandatory eligibility criteria, located at
www.wd-deo.gc.ca/eng/18771.asp. Project costs incurred by the Applicant Organization in the absence of a signed funding agreement with
WD are incurred at the sole risk of the Applicant Organization and that any such costs may not be considered eligible for WD assistance. Any person who has been lobbying on behalf of the Applicant Organization to obtain a contribution as a result of this application is registered pursuant to the
Lobbying Act and was registered pursuant to that Act at the time the lobbying occurred. The Applicant Organization has not, nor has any other person, corporation or organization, directly or indirectly paid or agreed to pay any person to solicit a contribution arising as a result of this application for a commission, contingency fee or any other consideration dependent on the execution of an Agreement or the payment of any contribution arising as a result of this application.
The information provided by the applicant on this application and in all supporting documentation is collected under the authority of the
Western Economic Diversification Act. This information will be treated in accordance with that Act and with the Access to Information Act and the Privacy Act. These laws govern, protect and limit the collection, use and disclosure of personal and confidential information by federal government departments and agencies. Information provided to WD is secured from unauthorized disclosure and use. WD acknowledges an individual's rights to privacy of their information, and personal information provided on this application is described in the Personal Information Bank entitled " Grants and Contributions (G&Cs) Programs", number WED-PPU-055.
For further information about WD's information holdings and your rights under the Access to Information Act and Privacy Act, consult the Government of Canada's Info Source publication at www.infosource.gc.ca.
WD, its officials, employees, agents and contractors to make enquiries of such persons, firms, corporations, federal, provincial and municipal government departments/ agencies, and non-profit, economic development or other organizations as may be appropriate, and to collect and share information with them, as WD deems necessary in order to assess this application, to administer and monitor the implementation of the subject project, and to evaluate the results of the project and related Programs.
68a. I have read and agree with the applicant acknowledgements: *
68b. Name: * 68c. Title: * 69. Date: