ABORIGINAL JUSTICE STRATEGY

CAPACITY-BUILDING FUND

Funding Application Form

The Aboriginal Justice Strategy’s Capacity-Building Fund is designed to support capacity-building efforts in Aboriginal communities, particularly as they relate to building increased knowledge, skills and training needs of community-based justice programs.

This application has four (4) steps:

Step 1. Tell Us About Your Organization 2

Step 2. Tell Us About Your Project 4

Step 3. Describe How the Funding Would Be Used 6

Step 4. Conditions and Signing of the Funding Application 7

In order to assist you in submitting a complete funding application, a Proposal Completeness Checklist is attached to this form. Applicants are also asked to consult the Capacity-Building Fund Guide for Applicants when developing their proposals, the Guide shows the type of detail that is needed for every section of the Application for Funding.

Please complete all of the steps in this funding application and provide all requested information as this is critical for review committee members to assess funding proposals. If you have any questions regarding completing this form or the Call for Proposals process, please contact the Aboriginal Justice Directorate at 1-866-442-4468 (toll-free) or the general mailbox at .

Step 1: Tell Us About Your Organization

1.  The legal name of the organization, mailing and website address.

Legal Name of Applicant Organization:

Mailing Address:

Website Address (URL):

2.  Authorized Official(s): Delegation of Authority To Bind The Organization

Name(s)

/ Title(s) /

Specimen Signature(s)

3.  Number Of Authorised Officials Required To Sign The Funding Agreement

4.  Project Contact

Name

/

Title

Mailing Address

Telephone Number:
( ) /

Fax Number:

( )

/

E-mail Address:

Financial Contact

Name

/

Title (Responsible for Financial Transactions)

Mailing Address (Financial Contact):

Telephone Number:
( ) /

Fax Number:

( )

/

E-mail Address:

5.  Is your organization incorporated?

Yes: / Federal
Provincial/Territorial
Registration Number:
Date of incorporation: (dd/mm/yyyy)
No: / Date your organization was established: (dd/mm/yyyy)

6.  Your organization is a/an (check one):

Band, First Nations, Tribal Council, local, regional or national Aboriginal organization*;
Agency or institution of regional/municipal government;
Non-profit community organization, society, or association that has voluntarily associated itself for a
non-profit purpose;
Provincial/territorial government;
Individual;
For-profit corporation (note: for-profit corporations must not make a profit on the work performed)
*includes non-profit Aboriginal Organizations

7.  What is the mandate of your organization?

8.  Describe the programs and services your organization provides:

9.  Describe the expertise and experience your organization has to undertake this project:

10.  Has your organization received funding from the Department of Justice Canada within the last three (3) years?

Yes / No
If yes, please check all Department of Justice Canada Funding Programs that apply:
Justice Partnership and Innovation Program / Supporting Families Experiencing Separation and Divorce Fund
Aboriginal Justice Strategy / Legal Studies for Aboriginal People Fund
Supporting Families Fund / Access to Justice in Both Official Languages Support Fund
Victims Fund / Contraventions Act Fund
If yes, is the current funding application for a continuation or next phase of one of these previously funded projects?
Yes / No

11.  For Quebec organizations only

(a) / Are the majority of your members from the Quebec public sector, i.e., appointed by the Government of Quebec, a minister, a government agency, a municipal body, a school board or another public agency?
Yes / No
(b) / Is your personnel appointed in accordance with the Public Service Act (of Quebec) (chapter F-3.1.1)?
Yes / No
(c) / Is more than half of your financing derived from Quebec public funds, that is, from the consolidated revenue fund, a government agency, a municipal body, a school body or another public agency?
Yes / No
(d) / If you have answered “yes” to one of the above, you must enclose a copy of the Order in Council allowing your organization to negotiate and enter into an agreement with the Department of Justice Canada.
Enclosed

Step 2: Tell Us About Your Project

Project Title:
Project Time frame: / to
Start Date (dd/mm/yyyy) / End Date (dd/mm/yyyy)
** Projects must be completed by March 31, 2014**

1.  Please describe your project:

(a) / What is/are the overall objective(s) of the project? Also include a list of the communities you expect to serve, participate and/or who will benefit from your project.
(b) / Please list the activities that will support the overall objectives of the project by completing the attached workplan (Appendix A).
(c) / What specific justice needs and challenges in your community will the project address?
(d) / Have you identified partners for this project? If so, please list each partner and indicate how they will support and or be involved with the project:
(e) / Have you included letters of support* from community member and/or partners for your project?
* Letters of support are strongly encouraged as community support is a factor that is assessed in the review of your application. Letters of support should indicate why and how the community member and/or partners support the project.
Yes,(letter(s) of support enclosed) No
(f) / Identify the target group(s) for whom the project is directed: (Please check all that apply)
Aboriginal children / Persons with mental health/addictions issues
Aboriginal youth / Persons with Fetal Alcohol Spectrum Disorder (FASD)
Aboriginal peoples / Justice-related professionals
Aboriginal women / Governments (federal/provincial/territorial)
Elders / Remote communities
Victims / Urban communities
Homeless persons / Northern communities
Community at-large / Other (Please explain:)
Persons with disabilities
(g) / What type of mechanism will you be using to measure and evaluate the success of your project? (Please check all that apply.)
Surveys
Questionnaires
Comment cards
Statistics
Other (Please explain:)

Step 3: Describe How the Funding Would Be Used

1.  How much funding are you requesting?

/ $

2.  Have you submitted an application for this project to any other funding organization(s)? If yes, please identify the source and amount of funding being requested.

Yes / No

Source

/

Amount Requested

/
/

3.  Please complete the attached Budget template (Appendix B). Be sure to identify all confirmed and unconfirmed revenues and expenses for the project.


Step 4: Conditions and Signing of the Funding Application

Conditions

Department of Justice Canada funding may be used only for the purposes specified in this application. Once the Department of Justice Canada has agreed to provide financial assistance, no substantial change to the project shall be made without the consent of the Department, and it shall be at the discretion of the Department to determine what constitutes substantial change in each case. Any funding not used for these purposes must be returned to the Department of Justice Canada.

The organization is wholly responsible for its own debts. The Department of Justice Canada will not consider any application to pay debts. If any part of this funding is used to pay salaries or honoraria, federal and provincial laws concerning salaries and source deductions must be applied (e.g., deductions for income tax and employment insurance.).

The organization must agree to comply with all provincial, territorial and federal legislation.

The Department of Justice Canada’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 and this program 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 other information about the organization in the Department's possession, the information provided to the Department will be treated in accordance with the Access to Information Act and the Privacy Act.

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

The designation PROTECTED (when completed) ensures that this information receives enhanced protection. When funding is approved, the amount of funding, the purpose for which the funds were granted and the name of the organization receiving the funding are considered public information.

I declare that:

·  the information in this application is accurate and complete;

·  the application is made on behalf of the organization named on page two (2) with its full knowledge and consent;

·  if financial assistance is provided, the organization will submit financial statements and activity reports as required by the Department of Justice Canada;

·  if financial assistance is provided, the organization will submit to an evaluation of the project funded, as required by the Department of Justice Canada; and

·  as the applicant of this project, I am not in conflict of interest.

Name of organization:
Name of person with signing authority:
Position in the organization:
Signature / Date (dd/mm/yyyy)

The Department of Justice Canada thanks you for taking the time to complete and submit an application for funding.


APPENDIX A

2013-2014 WORKPLAN

Project Title:
Objective:
Activity / Activity Lead / Timeframe / What do you expect to achieve?
1.
2.
3.
4.
5.


APPENDIX B

2013-2014 BUDGET

Project Title:
Revenue / Cash ($) / In-Kind
(if applicable)
Department of Justice Canada
Other revenue sources (if applicable)
Total Revenue
Expenditures
Personnel salaries and benefits (please provide details on positions, duration and pay rates for the services to be provided)
Professional and/or Facilitation Fees (list contractors below, i.e. Researchers, Meeting Facilitator, etc.)
Honoraria (please provide cost per person per day)
Travel * (please provide details on mode and cost of transportation, number of travelers, accommodation costs, meal costs)
Training
Supplies and materials
Cultural expenses/activities (provide cost breakdown for cultural gifts, gatherings, etc.)
General Administration (must not exceed 10% of the total project costs)
Other: (Please specify)
Total Expenditures

* Reimbursement for travel costs shall not exceed amounts prescribed in the Federal Government’s Travel Directive, available at: http://www.tbs-sct.gc.ca/pubs_pol/hrpubs/TBM_113/td-dv_e.asp.

APPLICATION CHECKLIST

Please ensure that your application package includes the following:

1 (one) original signed and completed copy of the application form
Workplan (Appendix A)
Budget (Appendix B)
Letter(s) of support attached (strongly encouraged)
For Quebec organizations only: Copy of the Order in Council attached.

Please Note: Due to limited funding, not all eligible projects will be funded.

Page1