Please complete the following Proposal Template. Information collected on this form will be used to review your Proposal. Your information is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act.

A.Information about your Organization

Name of Organization:

Mailing Address:

Principal Contact: Position:

Telephone:Mobile:

Email:

B.Description of Organization

Type of Organization:

For each question below, please answer using the drop down menu. Note: please click on the shaded area to view the drop down menu choices.

Please indicate the structure of your organization?

Does your organization have a vehicle(s) available to provide ATS service?

Tell us about your organization, the work that it does, and some of its accomplishments. (Limit 3500 characters, approx. 1 page)

C.The Need

Provide a rationale for why your community needs alternate transportation for seniors (e.g., population of seniors in community, current level of service provision, etc.). (Limit 3500 characters, approx. 1 page)

D.Attributes of Your Community that would Support the Pilot Project

Please describe the organizations in your community that support this project and outline the nature of their involvement. Please also include letters of support and commitment of partners in an appendix. (Limit 2500 characters, approx. 1 page)

E.Community Resources

Describe the community resourcesavailable to assist your organization with the pilot project (infrastructure, personnel, financial). Please describe your organization’s readiness to begin. (Limit 3500 characters, approx. 1 page)

F.Communication Plan

How will you engage community partners and participants? How will you create awareness of the project if your application is successful? How will you recruit potential staff and clients? (Limit 3500 characters, approx. 1 page)

G.Utilizing the Transportation Toolkit

Please provide a description of which aspects of the Transportation Toolkit your organization will focus on in developing and implementing your ATS service. Are there features of the Transportation Toolkit that your organization is already using? (Limit 3500 characters, approx. 1 page)

H.Perceived Benefits of the Pilot Project

What do you see as the most significant benefits of the project to your community? (Limit 1750 characters, approx. ½ page)

I.Anticipated Challenges and Barriers to Establishing this Pilot Project

What challenges has your organization faced so far in trying to develop and implement ATS service in your community? What challenges do you forsee in implementing the pilot project and how will you overcome these? (Limit 1750 characters, approx. ½ page)

J.Sustainability Plans

Highlight how theATS service will be sustained in your community after the pilot project is complete.(Limit 3500 characters, approx. 1 page)

K.Funding Information

Please complete the following table. Please also attach a detailed budget outlining all expected expenses.

Source of Funding / $ Confirmed / $ Anticipated / $ Total
Your Organization
Committed $
In-Kind $
Community Partners
Committed $
In-Kind $
Other
Total contributions from your organization and others:

L.Checklist

Have you remembered to include:

Letters of support/reference? Yes No

Application form? Yes No

Detailed budget? Yes No

M.Authorization

I certify that the information provided in this proposal is to the best of my knowledge true and correct and that I have the authority to make the commitments described in the application.

Name: Date:

Signature: ______

Send application to:

Online:

Mail:Tara Pidborochynski

6-40 University Terrace

8303 112 Street, Edmonton, AB

T6G 2T4

All applications (electronic or hard copy) must be received by Friday, December 7, 2016 at 1530 hours (3:30pm). Late applications will not be accepted.

1