Funding Application Form

Victims and Survivors of Crime Week 2016

The Power of Our Voices

PDF Version

Thank you for your interest in funding for Victims and Survivors of Crime Week. Please note that applications for funding are no longer being accepted. The deadline for submission was February 29, 2016.

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Victims Fund - Victims and Survivors of Crime Week

To raise awareness about the issues facing victims and survivors of crime about the services, assistance and laws in place to help victims, survivors and their families

Additional Information

This funding application form was developed to make the process as clear and as easy to complete as possible. Once completed this application should contain of all the necessary information that will be critical for making a funding decision. Several questions include tool tips (represented by a question mark to the right of the question) which provide more specific guidance on what information you should include in your response. The tool tips can be seen by hovering your cursor over the question or by clicking on the question mark (if present).

If you have additional questions while completing this application, staff would be happy to help you and are available by email at: victimsweek-semainedesvictimes@justice.gc.ca

Please note that funding is limited, and therefore, not all eligible projects will be funded. The Department of Justice Canada thanks you for taking the time to complete and submit an application for funding.

Office use only

File #

Date Received

Tell us about you

1. Applicant Information

I am an

  • organization applying for funding
  • individual applying for funding
  • other level of government applying for funding

Street Address (if outside of Canada please provide full address including city, state and country in this field)



City

Province/Territory

Postal Code

Phone

Fax

Website

2. Primary contact for this application

First Name

Last Name

Salutation

Title (if applicable)

Phone

Fax

Email

  • Authorized to sign on behalf of the organization / entity
  • Same address as main address provided above (if checked, skip address fields below)

Street Address (if outside of Canada please provide full address including city, state and country in this field)



City

Province/Territory

Postal Code

3. Would you like to add additional person(s) with signing authority? (2 maximum)

Person 1

First Name

Last Name

Salutation

Title

Street Address (if outside of Canada please provide full address including city, state and country in this field)



City

Province/Territory

Postal Code

Telephone

Fax

Email

Person 2

First Name

Last Name

Salutation

Title

Street Address (if outside of Canada please provide full address including city, state and country in this field)



City

Province/Territory

Postal Code

Telephone

Fax

Email

4. Is your organization a (select one)

  • Band, First Nation, Tribal Council, local, regional or national Aboriginal organization
  • Non-profit organization, society or association
  • Education-related institution or association (e.g. school board, university etc.)
  • For profit organization undertaking "not for profit" work
  • Research and/or evaluation organization
  • Other (please specify):

5. Is your organization incorporated?

  • Yes
  • No

6. Is your organization a registered band?

  • Yes
  • No

7. Is your organization registered as a charitable organization with the Canada Revenue Agency?

  • Yes
  • No

8. What is the primary work of your organization (300 words maximum)?






9. What is the mandate of your organization?




For Québec organizations only

Are the majority of your members from the Québec public sector, that is, appointed by the Government of Québec, a minister, a government agency, a municipal body, a school board or another public agency?

  • Yes
  • No

Is your personnel appointed in accordance with the Public Service Act (of Québec - Chapter F-3.1.1)?

  • Yes
  • No

Is more than half of your financing derived from Québec public funds, that is, from the consolidated revenue fund, a government agency, a municipal body, a school body or another public agency?

  • Yes
  • No

If you answer "yes" to any one of the three questions in this section, your organization is required to provide a copy of the Order in Council allowing your organization to negotiate and enter into an agreement with Justice Canada either with your completed funding application or before a formal agreement will be offered by Justice Canada. For more information about this requirement please see, "An Act respecting the Ministère du Conseil executive" (M-30) on the Government of Québec's website.

Information About You Project

10. Project Title

Project Details

Most projects that take place during Victims and Survivors of Crime Week fall into one of three general categories. Please choose the category / categories from the list below that best describe your event. If your event does not fall within one of the categories listed, please indicate what your project will be in the section marked "other."

My project will be a (n):

  • General or specific awareness-raising campaign, event, or ceremony (e.g.: a proclamation ceremony at City Hall, newspaper ad campaign etc.)
  • Event that draws specific attention to skills / research / advancements made respecting issues related to victims and survivors of crime (e.g.: training session, workshop etc.)
  • Event that recognizes the dedication of those that work to support and assist victims and survivors of crime (e.g.: volunteer recognition event, award ceremony etc.)
  • Other (please specify):

In the space below, please briefly describe the activities that will take place, why you want to take on this project and who will be affected by the project. (Maximum of 150 words).







Anticipated Date(s) of Event(s): ** Please note that your event must take place between April 1 and June 4, 2016. Planning and "wrap-up" activities may take place prior to and after these dates (between April 1, 2016 and June 30, 2016).

What is the approximate population of your community?


How many people are you expecting at your event?


Describe why your project is needed and how the project will address these needs (800 words maximum)?







To be funded, your project must relate to at least one of the priorities of the funding program you are applying to. Select the funding program priorities that relate to your project and explain how your project will address the priorities

  • Funding Program Priorities
  • Briefly explain how your project addresses the priority

11. Who will directly benefit (target population) from this project?

  • Children (0 to 12 years old)
  • Youth (12 to 18 years old)
  • Aboriginal peoples
  • Northern communities
  • Remote communities
  • Urban communities
  • Ethno-cultural or visible minority groups
  • Official language minority communities
  • Homeless persons
  • Persons with disabilities
  • Persons with mental health issues (including FASD)
  • Persons with addictions issues
  • Persons undergoing separation or divorce
  • Youth at risk
  • Youth involved in the justice system
  • Victims of crime
  • Justice related professionals
  • Other professional groups
  • Governments (provincial/territorial)
  • Seniors
  • Other (specify)

12. Explain how your project demonstrates sensitivity to diversity and gender equality issues (300 words maximum)







13. Explain how the objectives of sustainable community development will be supported (300 words maximum)







The Department of Justice is committed to enhancing the vitality of the English and French linguistic minority communities in Canada, supporting and assisting their development, and fostering the full recognition and use of both English and French in Canadian society

14. Describe how your project takes into consideration the needs of the French-speaking people outside Quebec or English-speaking people in Quebec (300 words maximum)







15. How will the results and findings of your project be shared or communicated? (300 words maximum)







16. How will you measure the impact or success of your project (select all that apply)?

  • Evaluation (including third party or in-house evaluations)
  • Satisfaction Survey
  • Pre- and post-participant questionnaires
  • Data collection against key performance indicators
  • Other (please specify):

17. If your project will be evaluated, indicate who will do the evaluation and provide an overall description of your evaluation plans or approach (300 words maximum)







18. Provide the name(s) of member(s) of your organization that will help to either deliver or oversee the project

Name and/or position title

Role / Responsibility

19. Will your project require the support or participation of others?

Name of Supporter

Describe the nature of the support (i.e. referral source, advocate, donating space, providing advice, volunteer etc.




Has the support been confirmed?

  • Yes
  • No

Is this a new or on-going relationship?

  • New
  • On-going

Project Workplan

20. What is the objective(s) of your project (must be specific, measurable, and possible to achieve - 3 maximum)?

First objective




Second objective




Third objective




21. Using this table, please list the activities including the timeframe, who will be responsible, and the outputs for each activity that you will undertake to complete this project.

Activity Title 1

Activity Title Timeframe (from-to)

Responsibility

Outputs (products and or services)

 

Activity Title 2

Activity Title Timeframe (from-to)

Responsibility

Outputs (products and or services)

 

Activity Title 3

Activity Title Timeframe (from-to)

Responsibility

Outputs (products and or services)

22. Budget

Current project start and end dates

Start Date (yyyy-mm-dd)

End Date (yyyy-mm-dd)

A) Justice Canada Cash Contributions

Expense Category Expense Description Fiscal Year(s):
2016-2017
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
Sub-Totals  
Grand Total  

B) Other Cash Contributions

Funding Source Expense Category Expense Description Fiscal Year(s):
2016-2017
 
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
 
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
 
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
 
  • Administrative fee
  • Audit
  • Evaluation
  • Office equipment, Furniture and Supplies
  • Other (specify in expense item text field)
  • Professional fees
  • Program delivery or direct program costs
  • Salaries (including fringe benefits)
  • Training
  • Travel
   
Sub-Totals  
Grand Total  

C) In-Kind Contributions

In-kind is the amount of funding* that is given in goods and/or services rather than money

Funding Source Expense Description Fiscal Year(s):
2016-2017
     
     
     
     
Sub-Totals  
Grand Total  

* The amount of funding is an estimate of the monetary value of the in-kind provided

23. If applicable, provide any additional information about this project that you think is relevant and that we should know (300 words maximum)






24. If you have received funding from the federal government within the past five years, was an audit conducted?

  • Yes
  • No

25. Does your organization receive a GST/HST rebate from the federal government?

  • Yes
  • No

PROJECT DELIVERABLES

Upon the completion of your Victims and Survivors of Crime Week 2016 project, you will be required to submit an electronic version of a Project Summary Report, which will be available to download from the Victims and Survivors of Crime Week 2016 website (www.victimsweek.gc.ca). Along with this summary report, please send in any products, materials and media coverage (e.g.: news clippings, blog entries, etc.) that were produced as part of your project and photos of the event (if applicable).

Please ensure that your Project Summary Report, any products, materials and media coverage produced as part of your project and photos of the event (if applicable) are submitted electronically to Justice Canada no later than July 31, 2016

Conditions

In the event that your funding application is successful, you will be required to provide banking information in order to permit electronic payments.

Departmental funding may be used only for the purposes specified in this application. Once the Department has agreed to grant financial assistance, no major change can be made to the project without departmental approval (in each case, the Department shall determine what constitutes a major change). Funds not used for these purposes must be returned to the Department.

The organization bears full responsibility for its debts. The Department will not consider any request for assistance in settling debts. The organization must agree to comply with all provincial, territorial and federal legislation.

The Department's financial contribution must be explicitly acknowledged and must be mentioned in publications funded by the Department. A typical form of acknowledgement is: "We acknowledge the financial support of the Department of Justice Canada".

With regard to the project or programming for which funding is requested, the organization shall agree to comply with the spirit and intent of the Official Languages Act by implementing the appropriate linguistic measures.

By signing this application, (the applicant) authorizes the Department of Justice Canada to disclose any information received in this application within the Department and the Government of Canada or to outside entities for the following purposes: to reach a decision on this application, to administer and monitor the implementation of the project or programming, or to evaluate the results of the project or programming after project completion. This disclosure of any information received in this application may also be used to reach a decision on any other application of the applicant for funding under any other departmental program.

In the event of an access to information request regarding the present funding application or any relevant information about the organization in the Department's possession, the information provided to the Department will be entirely disclosed, with the exception of personal information, which will be treated in accordance with the Privacy Act.

Any person lobbying on the recipient's behalf must be registered under the federal Lobbyists Registration Act.

Declarations

I declare that

  • the information in this application is accurate and complete;
  • the application is made on behalf of the organization named, whose name appears in knowledge and consent;
  • if financial assistance is granted, the organization shall undertake to provide financial reports on results pursuant to the requirements of the Department of Justice Canada;
  • if financial assistance is provided, the organization shall agree to an assessment programming pursuant to the requirements of the Department of Justice Canada;
  • no public servant or holder of public office, past or preseVnatlu,e s wahnidc Ehth iicss C oidne breach for the Public Sector or the Conflict of Interest Act shall derive a direct benefit from the requested funding;
  • this organization has not paid or agreed to pay, directly or indirectly, and agrees directly or indirectly, any contingency fees for the solicitation, negotiation or acquisition of funding for the purposes of this application.

Applicant

Name of Person with signing Authority

Position

I agree to the conditions and declarations


Date

Please email this completed form and additional documents to: victimsweek-semainedesvictimes@justice.gc.ca

Date modified: