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/Regional Collaborative Group

Name of Submitting Organization:

(Note: the Organization/Group that is applying does not need to be incorporated, but the Organization/Group as a whole must support the project that is being proposed. A letter of support will be required from individual members of the Organization/Group to demonstrate their support for the project).

Mailing Address:

Principal Contact: Position:

Telephone:Mobile:

Email:

B.Description of Regional Collaborative Group

The overall goal of this project is for MARD to work with anOrganization/Regional Collaboration Group in an identified rural region in the province of Alberta in the development of coordinated ATS service provision within the region. In the box below, tell us about your Regional Collaborative Group. That is, what is your Vision? Mission? and Objectives? Describe the organizations that are involved, the nature of their involvement, and their type and level of commitment. Describe how all stakeholders involved with this pilot project will contribute

to your initiative (Include letters of commitment and/orsupportin an Appendix). (Limit 3500 Characters - Approximately 1 page)(10 pts)

C.The Need

Provide supporting information as to theneed for a regional model of ATS service in your area (e.g., the overall population of seniors in the region; the overall population in each of the identifiedcommunities;current level of transportation service provision [public; for-profit; and not-for-profit]in the region and in each of the identified communities, etc.).What are the current unmet transportation needs of seniors in the region? Describe the existing problems/issues with existing transportation services from both the service provider and client perspective, and how your proposed service will address the unmet transportation needs of seniors. (Limit 3500 Characters- Approximately3/4of a page)(7.5 pts)

D.Capacity for Implementation of a Proposed Regional Model of ATS Service

Describe your current capacity to undertake this projectfrom an organizational, financial, and logistical perspective (e.g., organizational structure in place; ‘readiness’ of organizations in the region to collaborate; funding sources available and/or probability of receiving funding; availability of vehicles, drivers, etc.; level of support from communities for a regional model; identified barriers to regionalization and solutions). Describe existing and future demands between jurisdictions for a regional ATS service and your capacity to accommodate the increased demand in service.

(Limit 4000 Characters -Approximately 1 page)(15 pts)

E.Community Resources

Describe any other existing resourcesavailable to assist your Regional Collaborative Group with the pilot project (Key stakeholders, infrastructure, personnel, financial). What resources are available in the identified communities that will enable your Group to move forward with the project?

(Limit 3500Characters - Approximately ¾ of a page) (10 pts)

F.Engagement Strategy

Outline your engagement strategy for community partners and participants?

(Limit 3500Characters–Approximately ¾ of a page)(10 pts)

G.Identified Benefits of the Pilot Project

Describe what you see as the most significant benefits of implementing a regional ATS service in your community?That is – what are the benefits from both the service provider and client perspective? What are the expected benefits to the communities from the implementation of this service in your region?

(Limit 2500Characters - Approximately ½ page) (7.5 pts)

H.Anticipated Challenges and Barriers to Implementing a Regional Model of ATS Service

What are some of the challenges your Regional Collaborative Group has faced so far in trying to implement a regional model of ATS service? What other significant challenges does your group forsee in setting up your regional model? How will you overcome these challenges?

(Limit 1750Characters -Approximately ½ page) (10 pts)

I.Sustainability Plans

Describe your plans and any identified initiatives for ensuring the financial sustainability of your proposed regional model of ATS service?

(Limit 3500 characters - Approximately1 page)(15 pts)

J.Funding Information

Please complete the following table. Please also attach a detailed budget outlining all expected expenses. (15 pts)

Source of Funding / $ Confirmed / $ Anticipated / $ Total
Your Organization(s)
Committed $
In-Kind $
Community Partners
Committed $
In-Kind $
Other
Total Contributions:

K.Checklist

Have you remembered to include:

Letters of support/reference? Yes No

Detailed budget? Yes No

L.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, April 7, 2017 at 1530 hours (3:30pm). Late applications will not be accepted.

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