APPLICATION FOR ASSISTANCE

GRANTS AND CONTRIBUTIONS PROGRAM

Department of Culture, Language, Elders and Youth

Government of Nunavut

Instructions

Please print or type when completing this form
Attach a separate sheet to this application if you need more space
Submit application to:

Administrative office, Grants and Contributions
Department of Culture, Language, Elders and Youth
PO Box 1000, STN 800, Iqaluit, NU X0A 0H0
Phone:(867) 975 5500     Toll Free: 1-866-934-2035     Fax (867) 975 5523/5504/5522
Applications submitted to any address other than the one listed above will not be considered.

Name of Proposal

Type of Application

☐ COMMUNITY PROGRAMS (Cultural & Heritage, Culture & Communications, Elder, Youth, Arts, Toponomy, Capital Contributions)

☐ LANGUAGE (Inuktitut, Inuinnaqtun or French)

Section A (Individual ONLY)

Dr ☐ Ms ☐ Mrs ☐ Mr ☐ Miss ☐	First Name		Last Name
Mailing Address	Community	Postal Code		SIN (for processing cheques)
E-mail:		Date of Birth: DD/MO/YY		Telephone (Day)	Fax (Day)

Section B (Organizations ONLY)

Name of Organization
Mailing Address	Community	Postal Code
E-Mail	Telephone (Work)	Fax (Work)
If your organization is registered as a non profit organization, please provide the following:
Registration Number: Years registered: ☐

Organization Contact :

Dr ☐ Ms ☐ Mrs ☐

Mr ☐ Miss ☐

First Name

Last Name

Position with Organization

NOTE: If your organization is registered as a non-profit organization,registration papers must be
included with this application. If your group is not registered, please provide the name of the
member in whose name the contribution agreement and check are to be made out to."

Note: Funding received in one year does not guarantee continued funding in subsequent years.

Funding must be spent within the fiscal year for which it was awarded.On-going salaries for permanent
employees will not be funded.

Only one proposal per application.

Successful applicants applying as individuals are responsible for declaring total amount approved as income
for income tax purposes

Project Proposal

Please describe the intent of your project, how you plan on carrying out your project, and what your expected outcome will be. Be sure to include how your project will benefit Nunavut through either the promotion, preservation or protection of Inuit culture, heritage or language. Attach a separate sheet if you need more space.

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Continued

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Project Schedule

State your expected start and finish dates. Also provide a schedule for completing each step of your project.

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Additional Information

Provide any additional information that you think will add to your application.

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Assistance from Other Sources

List financial or other assistance being provided by any sources other than the Department of Culture, Language, Elders and Youth.
Name of Source	Contact Name	Telephone		Dollar Value






			Total (1)

List financial or other assistance that you have requested from sources other than the Department of Culture, Language, Elders and Youth.
Name of Source	Contact Name		Telephone	Dollar Value




		Total (2)
		Total all other sources Total (1) plus Total (2)

Previous Support

Please list any previous financial support you have received from the Department of Culture, Language, Elders and Youth.
Name of Project	Dollar Value	Funding Year

References

You must enclose at least two letters of support with your application. Please list below the persons who provided these letters of support. These letters will contribute to the success of your application.
Name	Telephone

Project Budget

Provide a detailed budget breakdown indicating costs for the proposal.
Description		Dollar Value



















	Budget Total
	Less funds from other sources (Page 5)
	AMOUNT REQUESTED from the Department of Culture, Language, Elders & Youth

Applicant’s Statement