Participant Funding Program - Application for Funding

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Participant Funding Program
Application for Funding

Please refer to "Part 2 How to Complete Your Application Form" of the guide entitled "Participant Funding Program" when completing this application.

Please print this page and send it with your authorized signature(s) to:

Participant Funding Program
Canadian Environmental Assessment Agency
22nd Floor, Place Bell
160 Elgin Street
Ottawa ON K1A 0H3
or
Fax: 613-948-9172

Step 1: Applicant Information

Name and location of project:
____________________________________________________
Indicate which phase of environmental assessment you are seeking support for:
Comprehensive Study Phase I of the Review Panel Phase II of the Review Panel Mediations
Name of applicant (individual or organization):
____________________________________________________
Web site address:
____________________________________________________
Legal name of applicant (if different):
____________________________________________________
Mailing address:
____________________________________________________
City / Town:
____________________________________________________
Province:
____________________________________________________
Postal Code:
____________________________________________________
Area Code / Telephone number:
____________________________________________________
Area Code / Fax number:
____________________________________________________
E-mail address:
____________________________________________________
If the application is for an individual or a law firm, indicate on whose behalf you are submitting this application.
Applying on behalf of him / herself or law firm Applying on behalf of an unicorporated entity
Name of unincorporated entity:
____________________________________________________ (Note: Applications will not be accepted from unincorporated entities in their own name.)
Name and title of contact person for corporation / organization / group / association:
____________________________________________________ If you represent an entity (incorporated or otherwise) supporting documentation, endorsing you as the entity's representation must be attached to this application.
Language of correspondence
English French
Area Code / Telephone number (if different):
____________________________________________________
Area Code / Fax number (if different):
____________________________________________________
Is your organization incorporated?
Yes No
Federal No.:
____________________________________________________
Provincial No.:
____________________________________________________
Business number (Canada Customs and Revenue Agency):
____________________________________________________
GST/HST rebate number:
____________________________________________________
GST/HST rebate %:
____________________________________ %
Have you applied or will be applying for funds from other sources to participate at this stage of the environmental assessment process?
Yes No
If yes, please specify how much and the source.

Describe your or your organization's major goals and mandate.

Describe your interest in the environmental assessment.

Step 2: Description of Proposed Activities

Describe your proposed contribution to the environmental assessment, including:
the objectives of your participation; your proposed activities for which you are seeking funding; and how these proposed objectives and activities may contribute to the environmental assessment's understanding of the anticipated effects of the project.
Identify your capacity to carry out the proposed activities.
(Describe relevant experience, expertise and skills you or your organization have that will help you to carry out your proposed activities.)
Describe why you believe your participation will bring an important and distinct perspective to the environmental assessment.

Have you or your organization made an effort to cooperate with other individuals or organizations in preparing a funding application?
Yes No
If yes, please specify name of individual / organization
____________________________________________________
How are the proposed activities incremental to your ongoing business?

Step 3: Funding Requested

Please summarize your request for funding of eligible expenses, using the following table (see part 2 of the guide entitled Participant Funding Program for information on each expense category):

Priority: High
Expense Category	Funding Requested
Local collection / distribution of information	$ ____________
Professional fees (excluding legal fees)	$ ____________
Travel expenses	$ ____________

Priority: Medium
Expense Category	Funding Requested
Office supplies	$ ____________
Rental of office space / meeting rooms	$ ____________

Priority: Low
Expense Category	Funding Requested
Staff salaries	$ ____________
Legal fees	$ ____________
General media advertising / promotion	$ ____________
Purchase of information material	$ ____________
Other (specify)	$ ____________

TOTAL funding requested from CEAA

$ ____________

With respect to each expense, please provide additional information to support your request:

Local collection / distribution of information:

Professional fees (excluding legal fees):

Travel expenses:

Office supplies:

Rental of office space / meeting rooms:

Staff salaries:

Legal fees:

General media advertising / promotion:

Purchase of information material:

Other:

How did you learn about the availability of Participant Funding for this project? (Please check all that apply)

Government of Canada
Government of Canada notice in newspaper
Newspaper articles/ editorials
Agency Web site
Consulting Canadians Web site
Other Web sites
Regional Agency office
E-mail to your organization
Direct mail to your organization
Radio broadcast
Word of mouth
Other (please specify): _____________________________________

Application for Funding: Certification Form

Certification and Consent:
I/we hereby certify that the information I/we have provided in this application is accurate to the best of my/our knowledge. In the event that a participant funding award is to be made based on this application, I/we agree that no funding will be payable unless I/we sign the Canadian Environmental Assessment Agency's standard Contribution Agreement. I/we understand that I/we was/were entitled to review a copy of the Contribution Agreement before signing this Application Form. I/we hereby consent to the Agency providing a copy of this Application Form and of the aforementioned Contribution Agreement (once signed by me/us and by the Agency) to any person that the Agency deems appropriate in the circumstances. I/we further consent to the Agency making copies of any written submissions during the environmental assessment process, by me/us or by the corporation, organization, group or association that I/we represent and to use those copies for purposes related to the administration of the Canadian Environmental Assessment Act. The information collected will be subject to the Access to Information Act.
Name

Title

Authorized signature

Date

Last Updated: 2007-01-04