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Business Scale-up and Productivity (BSP) Application

HTML Version – For Reference Only (not for submission)

If you are unable to submit your application using the online application tool, contact a Western Economic Diversification Canada Regional Office for assistance.

Refer to the Applicant Guide for instructions on completing the application form and eligibility criteria located at weblink.

You can complete this form in more than one session by saving the form using the Save button on the form. Once you have successfully saved your form, the Primary Project Contact Person identified on the form will be sent an email that can be used to retrieve the saved form. For more information, refer to section 3 to 5 of the Applicant Guide.

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

Before submitting this application, print a copy for your records.

Organization Information

16. Operating facilities existing in (check all that apply) *




17. Is the applicant organization a for-profit company registered in Canada? *
18. If incorporated, indicate all that apply:
18a.
18b.   
19. Your organization is headquartered in:





20. Is your organization a subsidiary of another company?
21. If Yes, provide company name and location:
21b. Location





Project Information

32. Primary Project Activity:


Primary Project Contact

Note: The Primary Project Contact will be contacted for any follow-up to this application. When the form is saved for the first time, an email will be sent to the email address provided in field "37. Email address:". This email is only sent the first time the form is saved, and contains instructions to retrieve the saved form.

Primary Contact

Secondary Contact

Project Description

Financial

 
49. Project Funder * Source * Confirmed * 2019-2020 2020-2021 Future Years Total *
Applicant organization
$ $ $ $
Western Economic Diversification Canada Gov't, Federal Requested $ $ $ $




$ $ $ $




$ $ $ $




$ $ $ $




$ $ $ $
Total Project Funding Required: * $ $ $ $
Applications must demonstrate that a minimum of 50% of the total project funding required is from confirmed non-government sources.
%

Confirmation of Funding Attachments

51. It is mandatory that you attach proof of all confirmed funding. (attach proof here) *


53.Project Costs (all costs will be validated) *
List the Capital and Non-capital costs you will incur during the implementation of this project
(only include costs incurred after the project funding start date).		 Amount *
$
$
$
$
$
$
$
$
Total Project Costs (Must equal total project funding required) $
54. What is your highest level of prepared year-end financial statements for the last two (2) years? *




56. Has your organization previously received funding from Western Economic Diversification Canada? *

Management

58b. Specify the number of individuals comprising the project management team who belong to each of the following groups *


59. Is your organization led by a board of directors? *
60. Identify any strategic or business partnerships you are involved with that will assist in supporting your project: *





Project Timelines

61. 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.
Key Activities * Completion Date *

Market

63. Do you have an independent market assessment or evidence of unmet market demand? *
63a. If Yes, attach your market assessment or evidence of unmet market demand. *
64. Does your organization currently do business in the indicated target market/sector? *

65. Competitors are operating within: *



*

Economic Benefits

67. Which priority will benefit from the proposed project? (select best fit) *





*
68. Estimate the following direct economic benefits to your organization resulting from this project. *
Note: these should be measured from the project funding start date until two years following the project completion date.
Complete 68a to 68d.
Where applicable, complete 68e.		 Amount
*
*
*
*
*

Required Attachments

69. It is MANDATORY that you attach a current business plan along with your year end financial statements for the last two (2) years. These must comply with the information requirements as outlined in the Applicant Guide.

It is recommended that you review the Applicant Guide and instructions prior to attaching your business plan and your financial statements to ensure that they fully meet the requirements.

  • required -    Business Plan *
  • required -    Technology Questionnaire (mandatory only if primary project activity selected in question 32 is "Technology Commercialization")
  • required -    Financial Statements (if not included in business plan, attach here)
  • required -    Forecasted income statements and cashflow (if not included in business plan, attach here)

Authorized Official of the Applicant Organization Acknowledgements

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 BSP application process including the mandatory eligibility criteria.
  • 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.

I authorize 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.

       

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* Signature of person with signing authority for the applicant organization
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