Application Form / Internal use only
Project #
Applicant Information:
Non-Profit Organization:Contact Name and Title:
Complete Address:
TelephoneNumber(s):
Email Address:
# of years in operation:
# of staff, volunteers and directors:
Date of last AGM:
What is the language of operation of your non-profit? Bilingual French English
Currently, or previously have received funding from/delivered contracts for: / ACOA :______/ GNB :______
Please indicate how you heard about the program:______
To be eligible for this program the non-profit organization must meet all of the following criteria:
**Please indicate that your organization complies by checking the appropriate boxes below.
[ ]Be an incorporated non-profit and/or a registered charity, as defined and recognized by the Canada Revenue Agency.
[ ] Be based in New Brunswick.
[ ]Be able to clearly demonstrate how the organization contributes to economic development in New Brunswick.
Provide a brief description of the non-profit organization:(Please include your mission statement)
Describe how the organization’s mandate directly and significantly contributes to economic development/business support in New Brunswick: (* please note, impact must be greater than employment of staff)
Which outcomebest describes what your organization aims to achieve by participating in this program?
**Please check as many as apply.
Clarify your organization’s mission and vision, as a key component to improving organizational capacity.
Improve overall management capabilities and skills of board members, staff and/or volunteers to meet the organization’s mission/mandate;
Enhance the governance structure, and board functionality to better ensure organizational accountability.
Please provide a brief description of the issues you wish to address by participating in this program:
Please provide a brief description of the steps, including previous training, consulting or mentoring, that your organization has already undertaken to address the issues raised above:
Attachments:
Please attach a copy of your articles of incorporation or a copy ofSNB corporate registry documents
Signature of CEO / Executive DirectorDate
If not applicable, Board President
Please print name
For further information please contact:LearnSphere Canada
565, Priestman st., suite 201,
Fredericton, NB E3B 5X8 / Tel:
Fax:
Email: Website: / (506) 452-0387
(506) 452-1890
A program of
Funded by the Government of Canada and the Province of New Brunswick through the Canada - New Brunswick Labour Market Agreements and the Roadmap for Canada’s official Languages 2013-2018: Education, Immigration, Communities.
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