POLICY DEVELOPMENT CONTRIBUTION PROGRAM
APPLICATION FOR FUNDING
Please consult the PDCP Applicant Guide for specific instructions for completing this application form as well as information about the assessment process.Section 1 - Project Information
Project Title
Proposed/planned Project or Event Start and End dates
Is your application for a single year project or a multi-year project? Single year projects finishon March 31st,2018. Multi-year projects finishMarch 31st,2019.
Single Year Multi-Year
Section 2 - ApplicantIdentification
Legal Name
Operating Name (if different than above)
Business or Registration Number(if applicable)
Business Address
City/Town / Province/Territory / Postal Code
Business Telephone Number / Business Email address
Section 3 - Organization Contact (if applicable)
Given Name/Surname
Position Title
Telephone number / Email address
Section 4 - Project Description
a) Project Stream (check one):
Communications/Information Exchange Projects
Innovative and Research Projects
Training and Skills Development Projects
b) Related Program Area (check at least one):
Emergency Management
Countering Crime
National Security
Border Strategies
Other (please specify)______
c) Project Objectives
d) Project Activities
e) Expected Results
f) Knowledge Transfer
g) Implementation Plan
h) Safeguarding Information
i) Risk Management
Section 5 –Capacity
Expertise
Section 6–Proposed Project Budget
Include a detailed budget of the amount sought using the form below:Annex A, Project Budget must be attached, detailing expenditures and revenues by fiscal year (April 1 – March 31).
Please ensure you consult item 9 of the Terms and Conditions for the Policy Development Contribution Program for eligible expenses. It is recommended you use the eligible expenses categories as much as possible when detailing your proposed budget in Annex A.
Please ensure you include all funding requirements in your budget, including any translation costs. Unaccounted costs can result in funding delays.
Section 7 - Disclosure
a)This proposal involves a prospective recipient who is subject to the Values and Ethics Code for the Public Service, the Conflict of Interest Act (S.C. 2006, c.9) or the Parliament of Canada Act (R.S. 1985, c.P-1.01):
No Yes, details are attached.
b)The proposal makes use of the services of a lobbyist, as defined by the Lobbying Act:
No Yes, details are attached.
c)The proposal involves a departmental official or reviewer who may sit on an advisory committee or board for the proposal:
No Yes, details are attached.
Section 8 - Declaration
Signature of Authorized RepresentativeDated:
Submit to:
By email:
By mail:PDCP
c/o Strategic Policy and Research Directorate
Public Safety Canada
269 Laurier Avenue West, 18th Floor
Ottawa, ON K1A0P8
1
ANNEX A - Project Budget
Revenues for Fiscal Years
April 1, 2017 - March 31, 2019
Project Title:
Government Funding(municipal, provincial, territorial, and federal) /Year 1: April 1, 2017 – March 31, 2018
/Year 2: April 1, 2018-March 31, 2019
/Total
Subtotal – CashSubtotal – In-kind
Total Government Funding
Government assistance XX% (municipal, provincial, territorial and federal)
It cannot exceed 95% of eligible expenditures
Non-government Funding and other
Subtotal – Cash[1]
Subtotal – In-kind[2]
Total Non-government Funding and other
Total Revenues:
Annex B- Project Budget
Eligible Expenses for Fiscal Years
April 1, 2017 – March 31, 2019
Project Title:
Detailed Eligible Expenditures by Category /Eligible Expenditures
Year 1: April 1, 2017 - March 31, 2018 / Year 2: April 1, 2018 – March 31, 2019Public Safety Canada Funding / Other Government Funding / Non-Government Funding and other / Total Year 1 / Public Safety Canada Funding / Other Government Funding / Non-Government Funding and other / Total Year 2
Subtotal – Cash[3]
Subtotal – In-kind[4]
Total Expenditures:
1
[1] Cash: actual dollar value or revenues/funding received
[2] In-Kind: non-cash input which is given a cash value
[3] Cash: actual dollar value or revenues/funding received
[4] In-Kind: non cash input which is given a cash