Fedoruk Centre Engagement Grant Report

Event Title:

Date of event:

Event organizer (Name, organization, address, phone number, email):

Applicant:

Prior to your event, please develop a strategy for telling the story, objectively, of how your event has contributed to the Fedoruk Centre’s goal of “placing Saskatchewan among global leaders in nuclear research, development and training” within one or more of Fedoruk Centre’s impact areas. Your story will be most effective if supported by facts based on data, observations, testimonials, feedback forms, attendance records, etc.

# of Undergrads / # of Masters / # of PhD / # of Post Docs / # of Faculty / # of Professional/
Technical
UofS
UofR
Other

Financial Report

Partnerships are integral to the fulfillment of Fedoruk Centre’s purpose; therefore, full event costs and all sources of funding both cash and in-kind should be reported. All amounts must be verifiable through accounting records, such as receipts, invoices, time records, valuation statements.

Financial Report
Expenses / $ Amount*
Travel Costs (transportation, accommodations, per diems)
Honoraria
Entertainment (social events, tours etc.)
Advertising
Venue
Office supplies
Personnel/Services (hours x rate including benefits)
Meals and refreshments
Printing
Other (specify)
Revenues Cash
Registration Fees
Other sources (name each partner)
CCNI contribution
Revenues In-kind
Contributing Partner / Item contributed* / $ Value of contribution

*For personnel time, include name of person, period (dates), number of hours, rate including benefits, and nature of work performed. A Personnel Confirmation Form is available for this purpose (www.fedorukcentre.ca/docs/personnel_confirmation.docx). For services, include name of company, number of hours, published rate, date, nature of work performed.

I hereby certify that the above information is accurate. I acknowledge that the Fedoruk Centre may request verification of the data contained herein in order to determine eligibility for funding.

Name / Signature / Date

Submit report to:

Operations Manager, Sylvia Fedoruk Canadian Centre for Nuclear Innovation Inc.

111 – 54 Innovation Boulevard, Saskatoon SK S7N 2V3;

Sylvia Fedoruk Canadian Centre for Nuclear Innovation Rev 20131016

Engagement Grant Report Template