Name of Proposal

Type of Application

Community Programs (Cultural & Heritage, Culture & Communications, Elders, Youth, Arts, Toponomy, Capital Contributions)

Language (Inuktitut, Inuinnaqtun or French)

Section A (Individuals Only)

Dr   Mr   Mrs   Ms   Miss	First Name	Last Name
Mailing Address	Community	Postal Code	SIN (for Cheques)
E-Mail	Date of Birth	Telephone	Fax

Section B (Organizations Only)

Name of Organization
Mailing Address	Community	Postal Code
E-Mail	Telephone	Fax
If your Organization is registered as a non profit organization, Please provide the following     Registeration Number      Years Registerated

Organization Contact:

Dr   Mr   Mrs   Ms   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

Project Schedule

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

Additional Information

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

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)

Other Sources

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
Amount Requested from the Department of Culture, Language, Elders & Youth

Applicant’s Statement

I hereby certify that the information contained in this application is true and correct to the best of my knowledge and belief, and that I do not have any outstanding commitments resulting from previous projects financed by the Department of Culture, Language, Elders and Youth or Government of Nunavut.
I Agree to the conditions Yes          No
Name of Applicant	Date
Name of Witness	Date