TOGETHER AGAINST BULLYING

Financial Assistance Program for Aboriginal Communities and Organizations

Funding Application

  1. Information on the applicant

Name of the applicant:
Mailing address:
City: / QC / Postal code:
E-mail: / Telephone:
Nation / Community: / Website:
Administrative region: / Electoral division:
1.1.Description of applicant (Aboriginal organization or community)
  1. Project

Name of project or activity (add details, if applicable):
Start date: / End date:
Project leader: / Position:
E-mail: / Telephone:
2.1Description of the project
(Summarize: activities, clientele, territory)
2.2Project context and bullying issues addressed
(current situation, needs, issues, possible solutions)
2.3Project objectives
☐ / Encourage Aboriginals to mobilize, commit and use their expertise to prevent and counter bullying.
☐ / Equip First Nations and Inuit communities and organizations with tools to prevent bullying against Aboriginals, and to intervene and provide support if such cases arise.
☐ / Encourage Aboriginal nations, communities and organizations to share their initiatives with each other.
☐ / Other. Specify:
2.4Project implementation
(Organization’s experience and project team’s expertise, material resources, action plan)
2.5Likely outcomes for the community
(intended outcomes of each activity, anticipated mobilizing effects, partnership, support from the community, sharing of Aboriginal knowledge and expertise, sustainability of tools developed as part of the project)
  1. Budget forecast (if funding has been confirmed, check the box and attach supporting documents)

Projected expenses

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Projected funding

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Supportconfirmed

$ / $ / ☐ /
$ / $ / ☐ /
$ / $ / ☐ /
$ / $ / ☐ /
$ / $ / ☐ /
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$ / $ / ☐ /
$ / $ / ☐ /
Total / $ / Total / $
  1. Required documents

☐ / Funding application, duly completed and signed
☐ / Duly signed resolution of the board of directors of the community organization or band council
☐ / Copy of the organization’s letters patent
☐ / Copy the most recent activity report
☐ / Copy of the most recent financial report
Additional pages may be appended if more space is needed
  1. Declaration

I certify that the information provided on this form is true and complete.
Signature (as applicable) / Date:
Name (in block letters):Cliquez ici / Position: Cliquez ici
  1. Application submission

Send the duly completed application and appended documents, if applicable, either:

By e-mail:
/ By mail:
TOGETHER AGAINST BULLYING
Aboriginal Projects (Projets ponctuels autochtones)
Secrétariat aux affaires autochtones
905, avenue Honoré-Mercier, 1er étage
Québec (Québec) G1R 5M6