Western Economic Diversification Canada
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11. Application Form Instructions

Applicants are strongly encouraged to use the online application form.

HTML and PDF versions of the application form are available, but will require applicants to print and sign the documents. In addition, the PDF form cannot be completed electronically. All hardcopy applications must be postmarked on or before June 22, 2016.

Consult Section 2 of this Applicant Guide to ensure you meet the mandatory eligibility criteria. You may not be able to submit the application if the mandatory eligibility criteria are not met. Incomplete applications will not be considered eligible.

You can complete this application form in more than one session by using the "Save" button on the form. An email will be sent to the Primary Contact (Question 23), providing the information needed to retrieve the saved version of the application. Please check your email spam folder if you do not receive the notification after completing the submission as it might have been classified as spam by your email server. It is important to note that all correspondence regarding the application will be sent to the Primary Contact's email.

Enter the required information in the space provided. An asterisk (*) indicates a required field.

Once your application is complete, remember to first print a copy for your records and then select the Validate / Submit button. If you submit an application with missing information in the mandatory fields you will receive an error message indicating which questions are incomplete. These questions must be completed in order to successfully submit an application.  Remember that a 'Saved' application is not a 'Submitted' application.

Organization Information

1. Full legal name of your organization: The legal name as shown on the certificate of incorporation/registration. Please ensure your full legal name is reflected. For instance, is your legal name "The City of Smithville" or "City of Smithville"?

2. Operating name if different than legal name: Provide the name the applicant organization is operating under if different from the full legal name of applicant organization.

3. Mailing address (Including suite, unit, apt #): The mailing address of the applicant organization

4. Mailing address line 2: Additional space to provide the mailing address.

5. City/Town: The city/town portion of the applicant organization's mailing address.

6. Province/Territory: The province/territory portion of the applicant organization's mailing address.

7. Country: The country portion of the applicant organization's mailing address.

8. Postal Code: The postal code portion of the applicant organization's mailing address.

9. Telephone: The telephone number at which the applicant organization can be contacted. Use the following format xxx-xxx-xxxx.

10. Facsimile: The facsimile number at which the applicant organization will receive faxes. Use the following format xxx-xxx-xxxx (note – not mandatory).

11. Email address: General email for the Organization. (All correspondence regarding the application will go to the Primary Contact's email address in Question 23).

12. Website: The organization's website address (if available).

13. Organization type: The type of organization that you are categorized into. Eligible organizations include:

  • A local or regional government established under provincial or territorial statue (select Government, Municipal (Local/Regional).
  • A public sector body that is wholly owned by an eligible applicant listed above (select Government, Municipal (Local/Regional).
  • A not-for-profit entity (select Not-for-Profit Association/Organization/Society).
  • An entity that provides municipal-type services to communities, as defined by provincial or territorial statute (including school boards and Metis Settlements) (select Government, Other Body).
  • A First Nation government, including a Band or Tribal Council or its agent (select First Nation).
  • First Nations businesses, if owned by the Band and if all profits accrue soley to the Band (select First Nation Business)

14. Business number or GST number: The unique business number (BN) or GST number assigned to the applicant organization by the Canada Revenue Agency. A BN or GST number must be obtained through the Canada Revenue Agency. Information on obtaining a BN:  http://www.cra-arc.gc.ca/tx/bsnss/tpcs/bn-ne/rgstr-eng.html.

  • Obtaining a BN
  • For unincorporated legions or other non-incorporated service clubs, please include your GST number here. If there is no GST number or business number, add the Branch number to Question 15 (e.g., BR197)

15. If an alternate number is used, indicate the type: If another number is used (e.g., band number, education number, branch number for unincorporated Legion and other non-incorporated service clubs), please provide it and describe what type of number it is.

  • In the special circumstance that the applicant organization is unable to obtain/does not require a BN, an alternate unique identification number may be used (e.g., a First Nations band number (3 digits) or a university).
  • If an alternate number is used, please enter it in the spaces provided for the BN, and indicate the type in the space provided. (e.g., Legion Branch Number)

16. Provide a brief summary of your organization and mandate: The description of the type of organization applying along with an explanation of the organization's mandate and priorities.

17. Corporate Status: Indicate if your organization is a for-profit or not-for-profit. It is recommended that you review Section 2.1 of the Applicant Guide for eligible organization criteria.

  • For unincorporated Legions or other non-incorporated service clubs, please choose not-for-profit.

18a. Indicate your incorporation status: Indicate whether the organization is:

  • Incorporated federally (unincorporated First Nations, Legions or other non-incorporated service clubs, choose this option).
  • Incorporated provincially.

18b. In the province of: Indicate in which province the organization is incorporated.

18c. Provide the date of incorporation: For unincorporated Legions and other non-incorporated service clubs, include the date the branch was created, typically contained in the Charter Document.

Project Contact Person(s)

This Primary Contact is the main point person(s) in your organization whom Western Economic Diversification will contact for all follow-up to this application. Please ensure that the email address and phone numbers are updated as required and that either the Primary or Secondary Contact listed below will be available for follow-up from June – August 2016.

Note: When the form is saved for the first time, an email will be sent to the email address of the Primary Contact person below. This email is only sent the first time the application form is saved, and contains instructions on how to retrieve the saved form.

Primary Contact

19. Salutation: Indicate the appropriate salutation (e.g. Mr., Mrs., Ms., Dr., etc.)

20. First Name: Provide the first name.

21. Last Name: Provide the family name.

22. Title: Provide the contact person's job title (e.g., President, Executive Director).

23. Email address (Save email recipient.): Provide a valid e-mail address. All correspondence regarding this application will go to this email address, including the email you will receive upon saving your application form for the first time.

24. Telephone: Provide a phone number where the contact person can be contacted. Use the following format xxx-xxx-xxxx.

25. Cell: Provide a cell number where the contact person can be contacted.Use the following format xxx-xxx-xxxx.

Secondary Contact

26. Salutation: Indicate the appropriate salutation (e.g. Mr., Mrs., Ms., Dr., etc.)

27. First Name: Provide the first name.

28. Last Name: Provide the family name.

29. Title: Provide the contact person's job title (e.g., President, Executive Director).

30. Email Address: Provide a valid e-mail address.

31. Telephone: Provide a phone number where the contact person can be contacted. Use the following format xxx-xxx-xxxx.

32. Cell: Provide a cell number where the contact person can be contacted. Use the following format xxx-xxx-xxxx.

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Project Information

33. Project Title: Provide a project title that accurately reflects the activities and outcomes of the project. Should your project be approved this description will be disclosed on Western Economic Diversification's public website as part of its proactive disclosure guidelines. The title must:

  • Start with a verb (e.g., produce, create, develop, expand, enhance, increase, support).
  • Concisely capture the essence of the project, and clearly identify the purpose/result expected through Western Economic Diversification's contribution — the project description must be understandable by anyone.
  • Examples include:
    • Upgrade Kimberley's Rotary Park playground
    • Modernize the Merritt Civic Centre
    • Install dehumidification system in the Aberdeen Community Rec Complex

34. Project Address is the same as Mailing Address (If checked, the Mailing Address will be automatically entered.): Indicate if the address at which the project will be undertaken is the same as the organization's mailing address.

35. Project address (Including suite, unit, apt #): If the project address is different from the mailing address, then enter the location at which the project will take place. For rural communities, this may be the legal land description.

36. Project address line 2: Additional space to provide the project address.

37. City: The city portion of the project address.

38. Province / Territory: The province/territory portion of the project address. Only projects located in Western Canada are eligible.

39. Postal Code: The postal code portion of the project address.

40. Short Project Description: Provide a clear and concise summary of the rehabilitation, renovation, repair or expansion work being planned. Organizations are encouraged to submit only one application. However, if submitting multiple applications, applicants are to clearly indicate the priority ranking of the projects in this field.   Examples include:

  • The Recipient will undertake activities to upgrade the YMCA facilities in the City of Regina. Activities to be undertaken include upgrading the boiler system to an energy efficient system; upgrading the child-care centre by installing in-floor heating, a new ceiling and lighting and new lockers and windows; installing a new HVAC system; and upgrading two entrance ways to make them wheel chair accessible. This project is priority #2 out of 5 applications submitted.
  • The Recipient will upgrade to energy efficient LED lighting at the Richmond Olympic Oval.  The Recipient will replace the lights located above the field, in the activity rooms, and in the outdoor areas of the Oval with LED lighting.  The project will increase the long term utility of the Oval by reducing maintenance and energy costs.
  • The Recipient will replace and upgrade the Dawson Creek Curling Club.  It will replace and upgrade the ice surface cement pad and its refrigeration infrastructure.  Project activities include removing the existing cement floor and header/brine lines, installing a new floor with an HDPE ploy fusion header/brine pipe system, and commissioning all the equipment.

41. Detailed Project Description: This should provide the department with a clear understanding of the project and your plan for completing the project including any potential risks that you may face.

  • Describe the objectives of the project.
  • Provide explicit details on the of the rehabilitation, renovation, repair or expansion work being planned.
  • Clearly address any project risks and mitigation measures to address these risks (e.g., project delays, staff turn-over and inability to secure confirmed funding).

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):  

  • Explain how the project will benefit the community or fill a community gap/need.
  • Explain the age, current condition of the facility and how the project would improve the use or longevity of the facility.
  • Describe the access and/or availability of similar infrastructure in the region.

43a. Community Infrastructure Type: Select the type of facility the project will improve/rehabilitate from either the "Recreational community infrastructure" list or the "Non-recreational community infrastructure" list. Choose only one.

43b. If "Other" non-recreational community infrastructure was selected, specify type:

44a. If non-recreational community infrastructure was selected in Question 43a, explain how the facility is used for recreational purposes: Indicate if the community infrastructure or part of it is used for recreational purposes (e.g., yoga, aerobics or basketball).

44b. If non-recreational community infrastructure was selected, identify the percentage of time that the facility is used for recreational purposes. Indicate the percentage of time (in whole numbers/no decimals) a facility is used for recreational purposes.

45. Does your organization own the community infrastructure which you are planning to rehabilitate or do you have a long-term lease and permission to undertake the renovations in place? Answer Own, Lease with permissions or Neither. If Lease with Permissions is selected it is mandatory to attach a copy of the lease in Question 66a.

46. Is the facility non-commercial in nature and open for use to the public and not limited to a private membership? Answer yes or no.

47. Does the project involve the rehabilitation, improvement, or expansion of existing community infrastructure assets? Answer yes or no. The Canada 150 Community Infrastructure Program is for rehabilitation and improvements to existing infrastructure.

48a. Does the project involve expansion (new construction) to the existing community infrastructure asset? Answer yes or no.

48b. If yes, identify the percentage (%) increase to the square footage of the existing community infrastructure asset. Indicate the percent in the space provided. Enter a value greater than zero with no decimal places. The Canada 150 Community Infrastructure Program will not support expansion activities that will result in a significant increase in the square footage of the facility (i.e., a 30 percent increase or greater).

49a. Can the project be completed by the Fall of 2017? Answer yes or no.

49b. If yes, explain how you intend to have the project complete by the Fall of 2017. Clearly indicate the project plan in place to ensure this project can be materially complete by the Fall of 2017. For instance,

  • Indicate if/when permits and approvals will be in place.
  • Indicate if/when engineering/architectural plans and approvals will be in place.
  • Indicate if/when a contractor will be hired and ready to work on the project.

50a. Does the project have demonstrated linkages to the Celebration of Canada's 150th? Answer yes or no.

50b. If yes, explain how your project will contribute to the Celebration of Canada's 150th? Clearly indicate how the proposed project will leave a meaningful lasting legacy for your community and how it will help your community remember the celebration of Canada 150 for many years to come.

  • Clearly indicate why the project is considered meaningful and how it will provide long-term benefits to a community.
  • Why would this project be viewed with pride by a Community?
  • Is this project for a facility that is a focal point for your community?
  • Will this project be viewed by your community as a meaningful legacy from Canada 150 and if so, why or how?
  • Was the facility originally constructed in 1967 as part of Canada's Centennial celebrations?

51a. Does the project have activities that will benefit Francophones? If your project includes activities that will directly impact Francophones in Western Canada, choose yes.

51b. If yes, describe how the project activities will benefit Francophones: Explain how the objectives of this project will benefit Francophones in Western Canada and what specific activity(ies) will be directed at Francophones.

51c. Will your project have a significant impact on Indigenous communities?  Answer yes or no.

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?). Refer to Section 3.3.

51e. Will your project advance a clean growth economy? Answer yes or no.

51f. If yes, describe how the activities will advance a clean growth economy. Refer to Section 3.2.

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Project Timelines

Indicate key activities that occur between the Proposed Project Funding Start Date and the Proposed Project Funding End Date.

52. Proposed Project Funding Start Date: This is the date that an agreement between a Recipient and the department comes into effect. It can be thought of as the start date for the project. Enter a date on or after April 1, 2016 in DD/MM/YYYY format.

  • Only costs incurred by the applicant between April 1, 2016 and March 31, 2018 will be eligible for reimbursement under the Canada 150 Community Infrastructure Program.

53. Is this date flexible: If your proposed project funding start date is flexible, choose yes.

54. Proposed Project Funding End Date: This is the anticipated date that project activity will cease. Under the Canada 150 Community Infrastructure Program projects must be materially completed by March 31, 2018 to be eligible and preference may be given to projects materially completed by fall 2017.

55. List key activities that occur between the Proposed Project Funding Start Date and the Proposed Project Funding End Date. Key activities are milestones that can be tracked to ensure the project is proceeding as planned: These should be significant activities that will be used to measure your project's performance over the course of the project. Examples include purchase equipment/materials, install equipment/materials, hire new staff and hire contractor (via competitive process if contract is over $50,000). If additional activities are required to adequately describe your project, the list can be expanded.

Completion Date: Key activity completion date must be completed. It must be a valid date in DD/MM/YYYY format and a date between the Project Start and End Dates.

Add additional Key Activities: If applying online, the application allows for adding additional fields for key activities.

56. Comments on Key Activities: Provide any additional information that may help to clarify the key activities and completion dates provided.

Project Funding

The funding summary will provide all sources of funding of the project. The applicant organization and Western Economic Diversification Canada are pre-identified on the form. Please enter all other sources of funding in the spaces provided and indicate if the funding from these other partners has been confirmed or not. If you are using the online application form and more space is required, click on "Add new source of funding" and an additional row will be provided.

57. Project Funder: List all project contributors that will provide project funding as a monetary contribution (see Section 10 for definitions).

  • Break down your funding by the Government of Canada fiscal year, which runs April 1 to March 31, and NOT by calendar year.
  • In-kind costs are not eligible.

Source: Where applicable, select the description that best reflects the funding source: Federal, Provincial, Municipal government body, or non-government.

Confirmed: For each funding source, indicate if the funding has been confirmed (yes) or not (no). In the case where your organization (Applicant Organization) is a source of funding, indicate confirmed if you have cash on hand.

Under each fiscal year column, provide the project funding cash flow. Each fiscal year commences on April 1 and ends on March 31.

Total Project Funding required: If you are using the online application form, this total is calculated automatically.

58. Comments on Project Funding: Provide further explanation of the sources of confirmed as required. If funding is not confirmed, indicate when you expect the funding to be confirmed. Identify if a request for additional funding has been made and whether you are waiting on a response or if the response is dependent upon funding from Western Economic Diversification.

NOTE:

Financial Statements: It is mandatory that you attach your most recent financial statements to your application.

Confirmed Funding: Please attach written proof of all sources of non–Western Economic Diversification funding that have been confirmed for your project. This may include copies of letters of confirmation, board motion approving commitment of funding, signed agreements, bank statements, etc.

59. Please list the various costs you will incur in the implementation of the proposed project (only include costs incurred after the Proposed Project Funding Start Date). Be sure to list costs and not activities: Under the Canada 150 Community Infrastructure Program only project costs incurred and paid between April 1, 2016 and March 31, 2018 are eligible for reimbursement. The cost categories are as follows:

  • Costs for rehabilitation, repair and expansion of fixed capital assets.
  • Professional Fees.
  • Public communications cost category must contain a dollar value equal to or greater than 200 with no decimals.
  • Incremental salaries.
  • Other project costs (please include any costs not listed above under 'other').

Invoices must be provided to Western Economic Diversification indicating that all costs (eligible for reimbursement under the Canada 150 Community Infrastructure Program) were incurred and paid between April 1, 2016 and March 31, 2018.  All costs will be validated and confirmed through the assessment and claim submission process. During the assessment and claim process, you may be required to provide evidence that the costs are reasonable for the product/service procured. This may include evidence of multiple quotations or proof of a competitive process. In the assessment process, applicants may be asked to provide this evidence on short notice and with a short deadline.

Amount: Total expected cost of items included in the corresponding cost category (including only the portion of GST that is not recovered/reimbursed).

Total Project Costs: Will automatically calculate if using the online application form. The dollar amount of total project costs must equal "Total project funding required."

Add additional project costs: If applying online the application allows for adding additional fields for project costs.

60a. Will a competitive process be used to select a contractor or for purchases (over $50,000)?: For individual project costs and contractors exceeding $50,000 indicate if a competitive process was/will be used.

60b. Please explain.

  • If yes, provide an explanation of the competitive process used/planned to be used.
  • If no, provide an explanation (e.g., justification for sole sourcing or project costs/contractors were under $50,000).

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Governance and Management

61. Describe the governance of the organization: Provide an explanation of how the applicant organization is governed (e.g., board of directors, advisory board) and its structure along with a brief explanation of key executives' credentials (e.g., indicate the level of experience of the board members, such as the number of years experience each member has on the board of directors). Clearly demonstrate that your organization has effective governance measures in place to provide appropriate oversight of this project. Indicate how these individuals will specifically be involved in providing oversight on the project.

62. Describe the qualifications and related experience of the key individuals who will be responsible for managing and implementing the project: Provide an explanation of the qualifications and experience of those members of your organization that will be directly managing and implementing this project. Clearly demonstrate that your organization has the management skills and leadership to carry out this project.

63a. In addition to the funding partners, are there any other organizations who are involved with this project: If there are other organizations involved with the project, in addition to the funding partners, choose yes.

63b. If yes, provide the organization's name, nature of their involvement and attach a letter of support (if applicable): Describe other organizations that are not funding partners in the project, but are involved in project activities or will benefit from the results of this project.

Add additional organizations: If applying online the application allows for adding additional fields for organizations that are involved in the project.

Attachments

64. Current Financial Statements (Maximum 1 attachment): It is mandatory that you attach your most recent financial statements.

65. Confirmation of other (non-Western Economic Diversification) sources of funding (no attachment limit): Funding will only be considered confirmed if written proof is provided. Evidence of confirmed other (non-Western Economic Diversification) sources of funding must be attached if 'confirmed' funding has been selected in question 57.

66a. Copy of lease, formal agreement, Memorandum of Understanding and/or other legal agreement (mandatory if "Lease with Permissions" is selected in Question 45).

66b. If your lease agreement grants permission to undertake renovations, please indicate which section, clause and/or page number the permission is highlighted in.

66c. If your lease does not provide permission to undertake renovations, attach a copy of the documentation granting permission from the owner. (Mandatory if 66b is unanswered)

67. Attach additional files that may support the assessment of your application (no attachment limit):

  • Project plan, timeline or Gantt chart.
  • For projects undertaking an expansion - provide proof (such as blueprints) that the expansion is less than 30% of the existing square footage/footprint.
  • Provide copies of engineering studies that confirm the need for the upgrades.
  • Letters of support.
  • Regulatory approvals.
  • Resolutions to proceed with the project.
  • Detailed budget (by fiscal year that starts April 1 and ending March 31).
  • Detailed project cash flow (provide a breakdown of costs by month starting April 1, 2016 and ending March 31, 2018. Also indicate if your project will incur costs prior to April 1, 2016 and who will cover these costs).
  • Documentation acknowledging construction readiness (e.g., construction permits).
  • Charter Document with a seal that grants Branch status and is signed and witnessed (for unincorporated Legions).

If you are using the online application form, attachments can be inserted and uploaded by clicking on "insert item. and then on "click here to attach a file".

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.

Also please remember that the application form must be submitted by the organization that owns the community infrastructure (or has a long term lease in place with approval to make renovations).

68a. I have read and agree with the applicant acknowledgements:

After reading and understanding the section, confirm agreement with the applicant acknowledgements, as well as the truthfulness of all the information provided, and fill in the subsequent information.

68b. Name: Fill in the name of the member of the organization with signing power/the authority to enter into an agreement. This person may be different from the contact person.

68c. Title: Fill in the title of the named member.

69. Date: Fill in the date of final submission. If you are using the online application you do not need to provide the date of submission.

70. Signature: Please sign the document. If you are using the online application form, you do not need to provide a signature on the document.

"Save" Instructions:

You can complete this application form in more than one session by using the "Save" button at the top of the application form. An email will be sent to the Primary Contact identified on the form. The Primary Contact must save this email as it is the only way you can retrieve your saved application. This email includes a link to your saved application and instructions on creating a GCKey which is required to access your saved application.

"Validate/Submit" Instructions:

  1. Save a final version of your application using the "Save" button at the top of the application form.
  2. Print a copy for your records.
  3. Select the "Validate/Submit" button at the top of the application form to formally submit your online application to WD. Once the validation of your application is complete you will have to select a second "Submit" button.
  4. The Primary Contact will receive a confirmation email upon successful submission. If you do not receive this confirmation email within 24 hours of submitting please contact a WD Regional Office. A "saved" application that is not formally submitted will be considered incomplete and will not be considered for funding.