In Partnership with the Aboriginal Sport Circle (ASC), the Esteem Team Association (ETA)

In partnership with the Aboriginal Sport Circle (ASC), the Esteem Team Association (ETA) has received funding from Sport Canada to develop an Aboriginal Role Model Program for Aboriginal communities across Canada with the goal of athletes and physically active Aboriginal Role Models inspiring young Aboriginals to take a leadership role in sport, recreation and physical activity within their own communities.

At this time, eight (8) pilot communities require selection for participation in the pilot phase of the project. For the purposes of the pilot (September 2006 – December 2006), the ASC and ETA are requesting interested Aboriginal communities to apply for consideration as a pilot community by completing the Pilot Community ApplicationForm according to the criteria, needs and descriptions as detailed below:

General considerations:

The ASC and ETA have established some objectives they will consider in selecting the eight pilot communities from the nominated communities list, as follows:

1. Achieve broad geographical representation (north, central, eastern and western Canada).

1. Achieve balance of communities: on reserve, off reserve, urban, rural, remote communities.

1. Achieve social representation: First Nations, Inuit, Innu, and Métis peoples.

1. Achieve balance in terms of the type of community in the pilot. There will be some communities who are already model communities and others that may have more challenges. We want to develop an understanding of how to work in all types of communities and are seeking a range of community experiences.

1. Is the community likely to be supportive of the initiative and/or do they have supportive adults in community, and/or strong leadership potential in youth in community?

1. Does the community already have involved youth or good potential for involving youth? Including their availability to, ability to, and interest in becoming involved in community.

1. Budget considerations do play a role in the choice of community. We have a limited budget that must cover all expenses to get the role model to and from the community three times as well as other administrative expenses involved in delivering the sessions and events in community. Costs to access more remote communities may be a limiting factor in the pilot but we will do our best to balance the needs to meet the objectives of the pilot.

Please proceed to complete the application form on the next 2 pages.

Please answer the following questions to the best of your ability.

1. What is the community name and where is it located?

1. Who is/are the leader(s)in the community with whom we would need to connect to confirm the community’s participation in the pilot program?

3. Is this a First Nations, Inuit, Métis or other type of community? Please describe.

4. How big is the community?

Total population?

Approximately how many people in the community are under the age of 25 years?

5. Is the community on reserve, off reserve, urban, rural, or remote (other, describe)?

1. Why do you think the community is a good candidate for this program?

1. What recreational, cultural and sport services and facilities are available to young people in the community?

1. What particular challenges, if any, do youth in the community face that make you feel they would benefit from a program of this nature? Please describe.

1. Are there any community programs that actively support youth and youth leadership in the community? If so, please describe them here.

10. Are there any young sport leaders in the community that you feel may be willing to help make the program a success in the community? If so please list their names and why you think they would be helpful.

1. Are there any adult leadersin this community that you feel may be able to help with delivering the program in the community? If so, please list their names and why you think they would be helpful.

1. Please provide your own name and contact information in the space below so that we may contact you if we have any questions.

We will review all applications and may call to gather more information if needed. We will let you know the status of your application by September 25, 2006. In the event that your community is not selected for the pilot phase of the program, your application will be kept for future consideration when the next phase of the program rolls out with an expanded number of communities after December 2006.

Thank you again for expressing your interest in the Aboriginal Athlete & Youth Role Model Program.

Fax or e-mail your completed form by Friday August 25, 2006 to:

e-mail: fax: (613) 789-9204

Please proceed to complete the next page to complete the application.