1. Information on the applicant

Organization: Click here / Contact: Click here
Project title: Click here
Email: Click here / Telephone: 555555-5555
  1. Information on the project

Realization of the project
Commencement date: Click here to select a date. / Completion date: Click here to select a date.
Actual figures for the project upon completion

Expenses

/

Amount

/

Revenues

/

Amount

anticipated

/

real

/

anticipated

/

real

Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Click here / $Amount / $Amount / Click here / $Amount / $Amount
Total / $Amount / Total / $Amount
  1. Overview of the activities carried out and spinoff from the project in the Aboriginal community

Click here to add text

… 2

2

  1. Overview of the activities carried out and spinoff from the project in the Aboriginal community (continued)

Click here to add text
Please append additional pages if you need more space.
  1. Companion documents submitted

☐Activity report of the organization / ☐Press review
☐The latest financial statements / ☐Surveys, studies, assessments
☐Photos, promotional tools / ☐Other (please specify): Click here
  1. Declaration

I declare that the information provided is accurate and complete.
Signature (where applicable) / Date:
Name (please print):Click here / Position: Click here
  1. Contact information

Please send the completed form and appended documents, as the case may be:

By email:
/ By regular mail:
Projets ponctuels autochtones(PPA)
Secrétariat aux Affaires autochtones
905, avenue Honoré-Mercier, 1er étage
Québec (Québec) G1R 5W5

V20140731