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Grant Application Form

Please complete all sections of the application form. This will speed up the evaluation of your proposal. Attach additional pages if required.

1. a) APPLICANT:

Name of organization: _________________________________

Address: _________________________________

City or town: _________________________________

Postal code: _________________________________

Telephone number: _________________________________

Fax number: _________________________________

E-mail address: _________________________________

Web site: _________________________________

Contact person: _________________________________

Title: _________________________________

Telephone number: _________________________________

E-mail address: _________________________________

b) Number of paying members: _____

c) Board of directors:

Name:___________________ Position or title:______________ Tel._____________

d) Briefly describe the objectives of your organization:

__________________________________________________________________________________

e) Non-profit organization charter number: ___________________________
or
charitable organization registration number: ________________________

2. LIST OF DOCUMENTS AND ITEMS ATTACHED

Please attach the following documents to your request:

Your organization's budget forecast and its most recent audited financial statements;
Letters of support for your project from individuals or organizations, including letters from your partners which explain the nature of their involvement;
Background information on your organization;
A mission statement/statement of principle/statement of philosophy regarding violence against women;
Evidence of liability insurance (per clause 15 of the Terms and Conditions);
Proof of approval of the Board of Directors for the Application (minutes of meeting, resolution, letter of approval, signature of signing officer);
Three tenders for each service contract over $2,000.

3. PROJECT DESCRIPTION

a) Provide a brief description of your project and attach a more detailed description if applicable.

Title: ________________________________________________________________________________

_________________________________________________________________________________

b) Please describe the type of project that you wish to undertake.

_____ Raising awareness in the Francophone community;

_____ Education and intervention in the area of the prevention of violence against women, among Francophone women and girls;

_____ Production of prevention tools and resources;

_____ Distribution of prevention tools and resources produced;

_____ Training of volunteers and stakeholders in the area of the prevention of violence against women.

c) What are the goals of your project?

_________________________________________________________________________________

d) Where did the idea for the project come from? What need(s) will this project address?

_________________________________________________________________________________

e) What types of activities in the area of the prevention of violence against women has your organization organized which target Francophone and girls?

_________________________________________________________________________________

f) Briefly describe your action plan and methodology, listing the project's main activities and the anticipated timeframe for completion.

_________________________________________________________________________________

g) Project start date: ____________________________________________________

Project completion date: ______________________________________________

h) Who is your target clientele and what are its characteristics?

_________________________________________________________________________________

i) Please indicate the number of people who would benefit from this project. Be specific: how did you arrive at these numbers, and what sort of impact will it be (direct, indirect, spinoffs, etc.)?

Number of women and girls at the local level ______

Number of women and girls at the provincial level ______

Number of organizations committed to the prevention of violence against women ___

Number of organizations not usually involved in the prevention of violence against women _____

Other target groups. Please specify:

_________________________________________________________________________________

j) What specific and measurable results will your project have? Please refer to your target clientele.

_________________________________________________________________________________

k) How will your project promote long-term changes in terms of the prevention of violence against women and girls?

_________________________________________________________________________________

l) What criteria will you use to evaluate the results of your project? Please check the methods that you will use to complete your evaluation plan:

___ Evaluation form completed by participants

___ Focus groups

___ Various measurements (e.g., increase in attendance, phone calls, participation in activities, increased knowledge of outside services, etc.)

___ Other (please describe):

_________________________________________________________________________________

Will the production and distribution of tools and resources be done over one or two years?

m) Have you asked other organizations to participate as partners in this project?

Yes _____ No _____

If yes, who are your partners and how will these partnerships help you to implement your project?

Partners' names	Nature of collaboration
_________________________	_____________________________
_________________________	_____________________________
_________________________	_____________________________
_________________________	_____________________________

n) How do you plan to share the results of your project?

_________________________________________________________________________________

o) If you receive a grant, would you allow us to post your e-mail address as a hot link on our web site?

Yes _____ No _____

p) Will there be a follow-up to your project?

Yes _____ No _____

If yes, what activities are you planning to ensure that the project continues to have an impact after completion?

_________________________________________________________________________________

q) In the last three years, have you received other grants from other funding sources for the same or a similar project? (Please note that having received such financing does not disqualify you for this application.)

Yes _____ No _____

If yes, please provide details in the following table.

Financing source	Year	Amount	Name of the project
____________________	______________	____________________________	___________________
____________________	______________	____________________________	___________________
____________________	______________	____________________________	___________________
____________________	______________	____________________________	___________________

4. PROJECT BUDGET

INCOME: Please identify all sources of funding for the project:	MONETARY CONTRIBUTION	NON-MONETARY CONTRIBUTION	CONFIRMED AMOUNT (TOTAL)	AMOUNT RECEIVED (TOTAL)
a) Your organization's contribution to the project (describe)
b) Your partners' contribution (monetary and other) Partner A Partner B Partner C
c) Other government or foundation programs (specify)
d) Other sources of income (specify)
e) Amount requested from the Public Education Program
TOTAL INCOME

EXPENDITURES: List all expenditures, identifying those that would be covered by the Program (for services over $2000, three tenders must accompany the request).	AMOUNT	USE OF GRANT REQUESTED FROM OFFICE













TOTAL EXPENDITURES:

5. a) SPONSORING ORGANIZATION (if applicable):

If your organization is not incorporated, you must be sponsored by a non-profit organization. Please complete this section.

Name of organization:______________________________

Address:______________________________

City or town:______________________________

Postal code:______________________________

Telephone number:______________________________

Fax number:______________________________

Contact person in the sponsoring organization:______________________________

E-mail address:______________________________

b) Number of paying members: ______

c) If possible, include background information on sponsor.

d) Board of directors:

Name:___________________ Position or title:______________ Tel._____________

e) Briefly describe the objectives of the sponsoring organization and its relationship to the applicant:

________________________________________________________________________

f) Non-profit organization charter number: _________________________

g) Please enclose sponsor's most recent audited financial statements.

SUMMARY

We suggest you fill this page after filling the rest of the form.

Important: please convey essential information without exceeding the maximum of words indicated.

Name of organization

Contact person

Telephone:

E-mail:

City or region where the project will take place

Overview of the organization (maximum 80 words)

Project name

Brief description of the project (maximum 100 words)

Amount requested

TERMS AND CONDITIONS

RECIPIENT - a) Any non-profit organization or association that has been duly incorporated for at least one year can apply for a grant from the VAWP Public Education Program. Individuals and unincorporated groups can also submit an application for funding provided they are sponsored by an eligible organization.
b) In the case of a sponsored application, it is understood that the sponsor endorses the project and assumes full responsibility for its implementation.
DURATION - The Office agrees to fund projects of a fixed duration. If a request for an extension is made by the organization, it must be made in writing. The Office may then ask for a progress report for the project, the reasons for the extension, and an action plan.
USE OF GRANT - It is understood that the money must be used for the purpose given in the letter from the Office. If any changes are required, they must receive prior approval from the Office. If the grant or a portion of the grant is not used up by the end of the project, the balance remains the property of the Office, but the Office may approve its use for other purposes, subject to a written request from the applicant.
REPAYMENT OF THE GRANT - The Office may demand (full or partial) repayment of the grant should the recipient:
- knowingly provide false information in its application for funding;
- fail to comply with the terms and conditions of the Program;
- declare bankruptcy, or be the subject of bankruptcy proceedings;
- cease operating, be discontinued or be dissolved.
If full or partial repayment of the grant is required, it shall be made immediately by a cheque made out to the Minister of Finance and forwarded to the Office of Francophone Affairs. The Office reserves the right to charge interest on any amount owing by the recipient. Interest will be charged at the then current rate charged by the Province of Ontario on accounts receivable.
OWNERSHIP, COPYRIGHT, PUBLICATION RIGHTS - The Office may require that the copyright of all publications and reports produced as a result of the project become the property of the Province of Ontario. In such cases, all working papers, data, reports and other documents relating to the project together with the copyright thereto shall become the property of the Government of Ontario from the time of their creation. They shall be surrendered to the Office upon completion of the project or upon such earlier termination as may occur. The Office may make available to any individuals, groups or the public at large any materials relating to or resulting from the project.
ACKNOWLEDGEMENT - Any product of a grant provided by the Office must acknowledge the Office's financial contribution.
QUALITY - Because the name of the Office is associated with the project, it is expected that any materials published, distributed or shown to the public and/or participants will have been professionally edited and be of good linguistic quality.
ONTARIO HUMAN RIGHTS CODE - Recipients must comply with the Ontario Human Rights Code. Any recipient convicted of a breach of the Code while undertaking activities funded by the Office must immediately repay the grant and will not be eligible for future grants from the Office.
CONSULTATION - The Office reserves the right to consult with other organizations to determine the eligibility of the applicant or the project for a VAWP Public Education Program grant.
ASSIGNMENT OF APPLICATION OR GRANT -The Applicant/Recipient shall not assign this application or any Grant or part thereof to another entity without the prior written consent of the Office.
PAYMENTS - Under the project, the grant may be paid to the recipient in several instalments. A portion of the grant may be held back until one phase of the project has been completed or until the project has been completed in full and all documents required by the Office have been forwarded to it.
FUNDING LIMITATIONS - As the amount of available funds is limited, the Office reserves the right to rank applications according to established priorities and criteria. The fact that an application has been received and examined and meets the criteria does not necessarily mean it will be approved. If a project depends on funding from the Office, the recipient should not begin any work or acquire any goods or services until a letter of approval has been received from the Office. If, due to unforeseen circumstances, the project must be started before written confirmation of a grant has been received, the recipient does so at his/her own risk.
ADDITIONAL CONTRIBUTIONS - The recipient may receive financial support from several sources. Funding of a project may be shared between the Office and other funding programs but the Office cannot approve a grant that duplicates another grant.
RECORDS - All statements of account and other accounting records must be kept in accordance with generally accepted accounting principles. The recipient's audited financial statements, for the fiscal year for which funding was granted, must make specific mention of the amount of the grant and the name of the Office. If the project is completed during the next fiscal year, the organization must provide audited financial statements for that year as well. The amount of the grant and the name of the Office must be clearly indicated. The accounting records of the recipient may be audited at any time by an auditor from the Office or by the Provincial Auditor. All records or financial statements relating to the grant must be kept for at least three years following the date of receipt of the last instalment of the grant. The recipient agrees to make all accounting records and other documents available to the auditor for review, on request, and will give the auditor access to the premises at reasonable times, and will allow him/her to copy said documents.
CONFLICT OF INTEREST - The Recipient shall ensure that the Project is carried out in all its aspects without a conflict of interest by any person associated with the Project in whatever capacity. For these purposes, a conflict of interest includes a situation in which the person associated with the Project and any member of his or her family is also to benefit financially from his or her involvement in the Project. Nothing in this section shall prevent volunteers from receiving reasonable out-of-pocket expenses incurred in connection with the Project. The Recipient shall disclose to the Ministry without delay any actual or potential situation that may be reasonably interpreted as either a conflict of interest or a potential conflict of interest.
LIABILITY, INDEMNIFICATION AND INSURANCE - The Recipient agrees to put in effect and maintain for the period during which the Terms and Conditions are in effect, at its own expense, with Insurers acceptable to the Office, all the necessary insurance that would be considered appropriate for a prudent Recipient of this type undertaking a project similar to the Project, including Commercial General Liability for third party bodily injury, personal injury and property damage to an inclusive limit of not less than two million dollars ($2,000,000) per occurrence and not less than two million dollars ($2,000,000) products and completed operations aggregate, and including, at least, the following policy endorsements:
1. Her Majesty the Queen in right of Ontario as represented by the Office as an additional insured;
2. Cross-liability;
3. Products and completed operations liability;
4. Owned and non-owned automobile coverage for bodily injury and property damage for vehicles used in connection with the Project;
5. Contractual liability;
6. Independent contractor's liability; and
7. a 30 day written notice of cancellation.
REPORT - Recipients must submit a report to the Office upon completion of the project. This report must include:
- balance sheet for the project;
- an evaluation of the project and its impact on the community;
- a sample of any materials produced with the financial assistance of the Office.
The Office can require that copies of supporting documents (receipts, bills, cancelled cheques, etc.) be submitted if it deems this to be necessary. The recipient will not be eligible for future grants until a satisfactory accounting has been made of all funding provided by the Office for previous projects, with full details of expenses covered by the grant.
ADDITIONAL TERMS AND CONDITIONS - The Office reserves the right to impose additional terms and conditions in its letter of approval to the recipient.
CONSENT TO RELEASE INFORMATION - The applicant/recipient consents to the release of information contained in its application and in any reports submitted under these terms and conditions, all pursuant to subsection 17(3) of the Freedom of Information and Protection of Privacy Act.
NON-EMPLOYMENT - Neither the terms and conditions of this document, nor the giving of the grant shall be deemed to constitute an employer-employee relationship between the Office and the recipient.
APPEAL MECHANISM - If an applicant disagrees with the Office's decision not to fund a project, he/she may request a review. In such a case, the applicant must submit additional information in writing, i.e., information not previously considered, so that the Office may re-examine the project proposal.

I hereby certify that the information contained in the application for funding submitted to the Office of Francophone Affairs is true, correct and complete in every respect, that the application is endorsed by the organization that I represent, and that the organization agrees to abide by the above terms and conditions.

_____________________________________________
Name of authorized signing officer of the applicant

_____________________________________________
Position or title

_____________________________________________
Signature

_______________________
Date - Day/Month/Year

For all projects sponsored by another organization:

_______________________________________________
Name of authorized signing officer in sponsoring organization

_______________________________________________
Position or title

_____________________________________________
Signature

_______________________
Date - Day/Month/Year

Grant Application Form

1. a) APPLICANT:

2. LIST OF DOCUMENTS AND ITEMS ATTACHED

3. PROJECT DESCRIPTION

4. PROJECT BUDGET

5. a) SPONSORING ORGANIZATION (if applicable):

SUMMARY

TERMS AND CONDITIONS

Office of Francophone Affairs

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