Multi-Year Project
Secrétariat à la condition féminine
Is this application form being filled out by an organization sponsoring an Aboriginal project? Yes No
If so, the name and description that follow must be those of the sponsor organization or band council.
Information on the Organization or Band Council
Name of the Organization or Band Council / Name of the Person in Charge
Postal Address
No. / Street / City, Town or Municipality / Postal Code
Administrative Region / Québec Enterprise Number (NEQ)
(does not apply to band councils)
Telephone: / Area Code / Fax: / Area Code / Email
Type of Organization / Website
Local Regional Provincial Band Council
Description of the Organization or Band Council
Mission
Community Ties
Is this organization a member of a broader network?
Yes No If so, which type(s): Local Regional Provincial
Current Human Resources
Number of Volunteers / Number of Paid Employees
Full Time: Part Time:
Members
Number of Individual Members / Number of Group Members / Date of Last General Meeting
Project Description
Project Title
Project Objective(s)
Check one or more objectives.
Promote non-stereotypical socialization of women, men, girls, and boys to facilitate parity in decision-making bodies.
Encourage targeted governing bodies to take action to ensure the fair distribution of decision-making positions at all levels.
Prepare and train women to hold and retain decision-making positions.
Financial Assistance Requested
Maximum amount awarded is $45,000 per project per year and must represent no more than 80% of project cost.
Project length (months): / Amount Requested
Multi-year project (36 months or less) months / 2011-2012: $
2012-2013: $
2013-2014: $
Problem Addressed by the Project
Ministère de la Culture, des Communications et de la Condition féminine Page 1 of 11
Project Description (cont’d)
General Description of Planned Activities (to be outlined in detail in the table on pages 4 and 5 of the form)
Anticipated Project Benefits for the Community
Documents to Include
Send the completed application form along with the following documents:
· A project description on 8.5" x 14" paper, including the information requested in the “Applying for the Program” section of the Information Guide;
· The resolution passed by the applicant organization’s board of directors designating the signatory for the application form and any future memorandum of understanding;
· A copy of the applicant organization’s charter and its Québec Enterprise Number (NEQ);
· A copy of the organization’s most recent annual report and financial statements approved at the last general meeting;
· Letters of undertaking from the project partners outlining their contribution, if applicable;
· The organization’s main achievements;
· For sponsored Aboriginal projects, a description of how the group responsible for carrying out the project was established as well as the band council resolution.
All requested documents must be included. The Secrétariat à la condition féminine will not contact you if any documents are missing. Your application will be considered using only the documents provided.
Return Address
Please send the completed form and
requested documents to
Equal Access to Decision-Making Program Information:
Secrétariat à la condition féminine Telephone: 418-643-9052
Ministère de la Culture, des Communications Fax: 418-643-4991
et de la Condition féminine Email:
905, Avenue Honoré-Mercier, 3e étage Website: http://www.scf.gouv.qc.ca
Québec (Québec) G1R 5M6
Deadline for sending applications and documents for multi-year projects:
Midnight, July 29, 2011
Signatures
Signature of the person designated by the applicant organization
Area Code
Date / Name (please print) / Signature / Telephone No.
Signature of the Aboriginal person responsible for carrying out the project
(For projects emanating from an Aboriginal community sponsored by a legally constituted organization or by a band council)
Area Code
Date / Name (please print) / Signature / Telephone No.
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2011-2012 Project Budget
1. Project Cost
1.1 Human Resources Allocated to the Project
Subtotal
1.2 Material Resources
Subtotal
Total project cost (A)
2. Contributions
2.1 Financial Contributions from Applicant Organization
Subtotal
2.2 Financial Contributions from Partners
Subtotal
2.3 Contributions in Services from Applicant Organization
Subtotal
2.4 Contributions in Services from Partner Organizations
Subtotal
2.5 Contributions from Clientele
Subtotal
Total value of contributions (B)
Amount of financial assistance requested (A - B) = / $
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2012-2013 Project Budget
1. Project Cost
1.1 Human Resources Allocated to the Project
Subtotal
1.2 Material Resources
Subtotal
Total project cost (A)
2. Contributions
2.1 Financial Contributions from Applicant Organization
Subtotal
2.2 Financial Contributions from Partners
Subtotal
2.3 Contributions in Services from Applicant Organization
Subtotal
2.4 Contributions in Services from Partner Organizations
Subtotal
2.5 Contributions from Clientele
Subtotal
Total value of contributions (B)
Amount of financial assistance requested (A - B) = / $
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2013-2014 Project Budget
1. Project Cost
1.1 Human Resources Allocated to the Project
Subtotal
1.2 Material Resources
Subtotal
Total project cost (A)
2. Contributions
2.1 Financial Contributions from Applicant Organization
Subtotal
2.2 Financial Contributions from Partners
Subtotal
2.3 Contributions in Services from Applicant Organization
Subtotal
2.4 Contributions in Services from Partner Organizations
Subtotal
2.5 Contributions from Clientele
Subtotal
Total value of contributions (B)
Amount of financial assistance requested (A - B) = / $
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Project Activities: 2011-2012
Activity / Activity Type / Results Indicator / Expected Results / Activity Description / Activity Cost / Partners Involved
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Project Activities: 2011-2012 (cont’d)
Activity Name / Activity Type / Results Indicator / Expected Results / Activity Description / Activity Cost / Partners Involved
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Project Activities: 2012-2013
Activity Name / Activity Type / Results Indicator / Expected Results / Activity Description / Activity Cost / Partners Involved
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Project Activities: 2012-2013 (cont’d)
Activity Name / Activity Type / Results Indicator / Expected Results / Activity Description / Activity Cost / Partners Involved
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Project Activities: 2013-2014
Activity Name / Activity Type / Results Indicator / Expected Results / Activity Description / Activity Cost / Partners Involved
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Project Activities: 2013-2014 (cont’d)
Activity Name / Activity Type / Results Indicator / Expected Results / Activity Description / Activity Cost / Partners Involved
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