Fisheries and Oceans Canada  



APPLICATION FOR INTERNSHIP FUNDINGSchedule A
 Official Use Only
Internship Number:
Science Horizons
Science and Technology Youth Internships Program
 
Applicant Information
Name of Applicant (Group or Organization)


Mailing Address


City/Town


Province


Postal Code


Area Code/Telephone Number


Area Code/Fax Number


E-mail Address


Location of Internship Activities and Field Work (City, Province) ___Private Facility  ___Public Facility


Name and Title of Applicant Contact


Area Code/Telephone Number (if different from above)


Language of Correspondence
_____ English_____ French
Applicant's Organization Type
_____ Private_____ Public_____ Non-profit
 
Intern Requirements
Duration of Internship Activities *
 YearMonthDay YearMonthDay
From





To





* Minimum of 6 months, maximum of 12 months, starting on or after April 1, 2001, completed by March 31, 2002.

Number of Youth Interns requested

Minimum Educational Requirements
_____ College_____ Bachelors_____ Masters_____ PhD
Discipline:
 
Internships Costs (only costs directly associated with the Youth Intern)
Proposed Internship Wage Costs
A.    Base Internship Wage Requirements: 
Number of weeks of employment: __________________
X                                  
Cost per week: $_________________
 
=  $_________________
B.    Mandatory Employment-Related Costs (e.g. - EI, CPP, QPP, etc.)+  $_________________
Total Internship Wage Costs (A+B):=  $_________________
 Official Use Only
Internship Number:
 
Sources of Funding

NOTES:
  • Funds obtained from Fisheries and Oceans Canada (DFO) are not to be used to pay for third parties assisting the Applicant in obtaining DFO finding. This includes the payment of contingency fees.
  • The Applicant must ensure that any person lobbying on his/her behalf is registered pursuant to the Lobbyist Registration Act (http://strategis.ic.gc.ca/SSG/1r01054e.html).


    • A. Federal Internship Funding Requested$
    B. Contribution of Applicant$
    C. Funding from Other Sources
    Specify(Group/Organization name(s) and amounts to be contributed):
     
    Group/OrganizationAmount
    		 $
     
     $
     $
     $
    Total Funding Sources (A+B+C):$
     
    In-Kind Contributions

    NOTE:
  • In-kind contributions are contributions that are not directly related to the Youth Intern's wages. Some examples include travel costs, office space rental, training, material and supplies, etc.


    •  ItemValue
    A. Contribution of Applicant (Please specify): $
     $
     $
     $
    Total Applicant In-kind Value:$
    B. Other Sources (Please specify):
    Group/Organization 
      $
      $
      $
      $
    Total Other Sources In-kind Value:$
    Total In-kind Contributions (A+B):$
     Official Use Only
    Internship Number:
     
    Proposal Description
     
    Please attach the following information:
     
    1.Internship Title
    2.Internship Objectives
    3.Proposed activities and timelines
    4.Expected results
    5.Means by which success will be measured
    6.Brief description of Applicant's background and expertise
    7.Past Internships funded through Fisheries and Oceans Canada and the Internship's achievements (is applicable)
    8.Name of Fisheries and Oceans Canada Internship Collaborator (if known)
    9.Statement identifying whether or not you have any Accident Insurance for the potential Youth Intern
    10.Statement identifying whether or not you owe any amounts to the Government of Canada under Legislation or Contribution Agreements (Is yes, please identify amount owed, nature of the amount owed - taxes, penalties, overpayments - and name of the government department or agency to whom the amount is owed). Please note that any amount that may be provided by Fisheries and Oceans Canada, under the potential agreement that could be established as a result of this application, may be offset against amounts owing to the Government of Canada.
    11.Environmental impact of proposed Internship activities (if any)
     
     
    Applicant Certification
    We certify that the above is an accurate description of our organization and our plans for the specified Internship
    Name (please print)

    		Title

    Signature

    		Date

     
    Official Use Only
    Internship Number:

    		_____ Approved_____ Approved Pending Funding_____ Not Approved_____ Withdrawn
    Name and Title of Authorized Officer (Please Print)

    Signature

    		Date