Loblaw Water Fund
PART 2: Proposal Form
Send complete packages to:
Emily Giles, Freshwater Program Manager
Email:
Please refer to theLoblaw Water FundGuidelines when filling out this form.
Proposals will be received electronically until 5pm E.S.T. onDecember 15th, 2014. Proponents will be notified of the outcome of their proposal in March of 2015.
NOTE: Only proposals that are completed in full will be considered.
Successful proponents will have from April 1, 2015until March 31, 2016 to complete projects and to report results to WWF-Canada.
Project Title
Please provide a descriptive title of the proposed project. (15 Words Maximum)
Proponent Information
Proponent Organization
Submitting Individual (Name and Title)
Signing Authority (if different from above)
Mailing Address
Unit No. / Street No. / Street Name / PO Box
City/Town / Province / Postal Code
Telephone No. (incl. ext.) / Fax No. / Email Address
Website (if applicable)
Please provide a brief description of the proponent organization (or a biography of the submitting individual, as appropriate) including relevant conservation experience and proven achievements.(Maximum 150 words)
Proponent Type
Please indicate which category best describes the Proponent Organization.
Registered Charity
Charitable Registration Number:
Other Qualified Donee:(Other Qualified Donees must be listed on the CRA websiteat time of applying: )
  • Municipality
  • Municipal or public body performing a function of government within Canada

Non-Profit Organization
Business Number:
Project Type
Restoration: Monitoring: Includes both Restoration and Monitoring:
For Monitoring activities, please indicate how this data will be used:
Contributes to a national data program
Name of Program:
Contributes to a long term monitoring effort
Name of effort:
# of years running:
Contributes to Data Deficiencies as highlighted in WWF’s FHA’s :
Which watershed?
Which indicator?
Has the proponent organization been a past recipient of a Loblaw Water Fund or other WWF grant?
Yes No
If yes, state the type of grant, name of the project, and when it was received:
How essential are volunteers for the completion of your project work?
Critical for project completion
Appreciated, but not essential
Not applicable
If volunteers are needed for your project what types of activities would they be doing? (e.g. invasive species removal, planting native plants, collecting water samples, etc.):
Brief Project Summary
In the space provided, briefly and concisely describe your proposed project. This brief summary may be used in news announcements and communication materials regarding the Loblaw Water Fund.
(150 word maximum)
Project Location
Province/Territory:
Closest City or Town:
Watershed or name of water body:
Please provide geographical or other descriptive information in relation to your proposed project (i.e. watershed, name of water body, closest park or other geographic marker). What is the current ecological state of this region? Does it contain rare or unique features, or anyspecies at risk? (250 word maximum)
Project Description
What are the goals and objectives of the project?How will this project deliver on the Loblaw Water Fund objectives outlined in the Loblaw Water Fund Guidelines?(250 word maximum)
Workplan
Set out the specific activities you will undertake to accomplish the stated objectives, deliverables and estimated timelines to complete the project by March 31, 2015.
Describe Specific Activity in Detail / Deliverables / Start Date
(yyyy/mm/dd) / End Date
(yyyy/mm/dd)
Who will do the work? Will you collaborate with other key stakeholders on this project?Will members of the local community be involved? (250 word maximum)
How will you measure whether or not your project has been successful? (250 word maximum)
Communication of Results
How do you plan on communicating the results of your project? (250 word maximum)
Local Support
Please provide the names and contact information of at least two professionals in the conservation community who support this project.
Contact Name / Organization / Position / Email Address / Telephone No.
Budget
Complete the following budget breakdown, specifying the costs associated with your project. Please keep in mind the following points:
  • Expenses to be covered by the Loblaw Water Fund must be clearly identified.
  • Expenses must relate directly to the activities in your workplan. Show how estimates were made for any line items over $1,000 (e.g., GIS technician = $200/day, 10 days x $200.00 = $2,000.00)
  • The Loblaw Water Fund will not fund 100% of the project costs – matching funds from other sources must be secured.
  • In-kind donations can be included under Revenue and include donated services, equipment, materials, and volunteer time.
  • Show all sources of funding and contributions.

REVENUE / Amount ($) / Secured?
If no, list expected confirmation date
Yes/No / (yyyy/mm/dd)
Amount Requested from Loblaw Water Fund:
Government grants – List all departments or agencies
Foundation grants – List all Foundations
Private sector funding – List all private sources
Funding from individuals - List all individuals
Other (please specify)
In-kind Donations (can include donated services, equipment, materials, and volunteer time)
Services:
Equipment:
Materials:
Volunteer Time:
Total Project Revenue
Budget justification(explain how the value of in-kind contributions has been determined,andprovide any other additional revenue information as needed)
EXPENSES
/ Specify amounts ($) from
Loblaw Water Fund / Other
Staff - Specify positions, full time, part time
Supplies and equipment - Specify equipment and field supplies
Travel - Detail trips and costs
Other (please specify)
Total Project Expenses
Budget justification: (Provide the names and brief qualifications of people that will be paid salaries or fees, and any other additional expense information if needed).
Permits and Volunteer Support
Would you welcome visitors in your field work?
Yes No
I confirm that the appropriate permits and/or licences have been obtained, or will be obtained in time for the proposed work to be completed.
Yes No
Agreements and Signatures
The undersigned hereby agree to all conditions outlined in the Loblaw Water Fund Guidelines, including those regarding eligibility, reporting, financial accounting and acknowledgement of Loblaw Water Fund co-sponsors, and verify that the information provided in this application is accurate and true to the best of their knowledge.
Proponent Signature
This should be signed by the lead proponent for the project.
Lead Proponent Name / Title/Position
Signature / Date (yyyy/mm/dd)
Signing Authority Signature (if different from above)
Proposals must be accompanied by a signature of an authorized officer of the proponent organization.
Signing Authority (if different from above) / Title/Position
Signature / Date (yyyy/mm/dd)

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