Youth Internship Program - Private Sector Component Application Form

When completed, the package should be returned to the FedNor office closest to you.

FedNor
6th Floor, Suite 600
70 Foster Drive
Sault Ste. Marie, Ontario
P6A 6V4
Toll Free: 1-877-333-6673
Fax: (705)941-2085

FedNor
19 Lisgar Street
Room 307
Sudbury, Ontario
P3E 3L4
Tel: (705) 671-0711
Toll Free: 1-877-333-6673
Fax: (705)671-0717

FedNor
244 Lincoln Street
Mezzanine
Thunder Bay, Ontario
P7B 5L2
Toll Free: 1-877-333-6673
Fax: (807)346-8474

FedNor
38 Pine St. North
Suite 112
101 Mall
Timmins, Ontario
P4N 6K6
Toll Free: 1-877-333-6673
Fax: (705)267-4939

FedNor
107 Shirreff Avenue
Suite 202
North Bay,Ontario
P1B 7K8
Toll Free: 1-877-333-6673
Fax: (705)494-4227

1. APPLICANT INFORMATION

2. PROJECT DESCRIPTION / STATEMENT OF WORK TO BE UNDERTAKEN

Please select applicable category that best describes your project activities. (Please refer to Program Eligibility Criteria for category description.)

The Statement of Work for the Youth Internship Program should clearly set out the following:

A. The objectives and tasks to be performed by the intern (job description);

B. The Work Plan detailing the following:

a) Outline of specific tasks

b) Anticipated results / deliverables / outcome

c) Method of measuring results

d) Anticipated impact and benefits for the Intern; particularly, long-term employment potential, either with your organization or otherwise.

e) Time frame to accomplish tasks within 12-month employment period.

C. Name of Intern’s Supervisor / Mentor

3. PROFILE OF COMPANY:

Total sales per year (approx.)

4. HIRING PROCESS:

Please provide a short description of the proposed hiring process.

5. FINANCIAL INFORMATION

Note:

1. The salary for intern and employee benefits are eligible costs while there is an “Employer-Employee Relationship.” Such relationship exists when there is a verbal or written agreement in which an employee agrees to work on a full-time basis for an employer for a specified period of time, in return for salary or wages.
2. Are you applying for any other Municipal, Provincial or Federal assistance for this Youth Internship? If yes, please explain.
3. FedNor will pay up to 50% of the approved costs of the project up to a maximum contribution of $27,500 per intern.
   • Detailed instructions and claim forms will be provided to applicants after their projects are approved by FedNor. However, applicants may find the following general information useful in their financial planning.
   • Applicants are required to maintain proper books and records of the costs of the project, including invoices and cancelled cheques, and to provide FedNor auditors with access to these records when requested.
   • In order to receive payment, applicants must file a claim.
   • Applicants may claim 90% of the approved FedNor contribution during the implementation phase of the project. The final 10% of the approved FedNor contribution will be released following completion of the project, upon submission of the required final report and Exit Interview form.

6. SUPPORTING DOCUMENTATION

Please attach the following required supporting documents to complete your application package.

7. CERTIFICATION

Any application not signed by the proper authority of the company cannot be processed.

The undersigned certifies that all information provided to FedNor in support of this request for funding is true and complete, and undertakes to provide any further information that may be required for FedNor to render a decision, in a timely manner.

The undersigned also herewith provides consent tor FedNor to make sufficient credit and other enquiries that may be necessary in the evaluation of this request for funding.

The undersigned also certifies that no additional funding has been applied for in regards to this project; and,

that the Applicant (organization or firm) is current on all obligations to the Government of Canada under agreements for other financial assistance; that the execution of the proposed project will not prevent the applicant from continuing to meet these obligations and from maintaining the economic benefits anticipated by the other agreements; and that these obligations will not preclude the applicant from fulfilling its obligations under the proposed project.

Signed this _________ day of ________________, _________.

___________________________________________________
Signature (Officer with signing authority for the Organization)

____________________________________
Title

Confidentiality: No commercially confidential information which you submit to us will be disclosed unless otherwise specified by you; required to be released by law; or required by the Minister of Industry to be released to an international or internal trade panel for the purposes of the conduct of a dispute in which Canada is a party or a third party intervener. Information on the federal government’s Access to Information Act is available on the following Web site: http://www.canada.justice.gc.ca/en/ps/atip/index.html Any information that you wish to be considered as confidential should be annotated accordingly.