FUNDING APPLICATION FOR LOCAL YOUTH ACTION FUNDING

Project Application Form

DATE OF FILING THIS APPLICATION

 
 

APPLICANT/CONTACT INFORMATION

We want to know who is leading the project.
 

FULL NAME OF THE APPLICANT

 

POSITION/ROLE

 
E-MAIL

 
TELEPHONE

 

FAX

 

ORGANIZATION INFORMATION

We want to know which organization is sponsoring your project because LYAF can’t give money to individuals.
 

NAME OF THE ORGANIZATION

 

ADDRESS

 

Type of organization who sponsoring the project

Northern Village (NV)Non-Profit OrganizationSchoolCLSCDay CareChurchYouth CenterStudent CouncilBand CouncilPrivate businessOther

 

Other

 

PROJECT DETAILS

We want to hear about the scope and potential impact of your project.
 

NAME OF THE PROJECT

 

STARTING DATE OF THE PROJECT

 

ENDING DATE OF THE PROJECT

 

GENDER OF CLIENTS TARGETED
MaleFemale
 

AGE GROUP TARGETED
0-12 y. old12-18 y. old19-25 y. old26-35 y. old36-50 y. old51 + y. old
 

Number of people who will benefit from the project:
0-1515-5050-100101-200201 +

Duration/Frequency of the project
Every weekEvery month1-2 time(s)/year3-5 times/yearOther
 

Other

 

Previous history
New project for the communityProject that has experience in the community
 

Which community is the project targeting?
KangiqsualujjuaqKuujjuaqTasiujaqAupalukKangirsukQuaqtaqSalluitIvujivikAkulivikInukjuakPuvirnituqUmiujaqKuujjuaraapikChisasibiOther
 
Other

 

The location of the project
On the land/outdoorsYouth HouseOutside of the Northern regionSchool or Day CareCommunity CenterOther
 

Other

 

What are the core values of this project?
Promote Inuit culturePromote active lifestylesPrevent suicideEncourage community mobilizationStimulate intergenerational dialogueEncourage students to stay in schoolPromote Inuktitut languagePrevent alcohol and substance abuseEncourage more cooperation with other Inuit organizations.Reinforce the understanding of the identity, culture & ancestral heritageWork towards getting more jobs for the youth
 

Other

 

Tell us about the project
 
¨(Where the idea came from, what is the mission, what is your general plan)

 

Tell us about the activities and main actions to be done with the project:

 

Tell us about the people involved in the coordination of the project:

 

Tell us about the people you are targeting with your project:

 

Tell us about the goals (results expected) of the project:

 

Why should QYC provide your project with funding?

 

THE FUNDING NEEDS

We are looking to have more details of the budget and expenditures of your project to evaluate your financial needs.
 
Provide more information on the provisional budget of your project:
Expense categories

 

Amount budgeted

 

Amount requested to QYC

 
 

Provide more information on other sources of funding:
Applications sent to

 

Amount requested

 

Amount confirmed

 

How much money does your project expect to receive from QYC?
$ 0-500.00$ 501.00-2,000.00$ 2,001.00-5,000.00$ 5,001.00-10,000.00$ 10,001.00 +
 

What is the main usage of the money received from QYC?
Remuneration, wages or honorariumTravel and accommodation expensesEquipment (motor vehicle, clothing, sports gear, electronic devices, etc.)FoodProfessional feesCommunications, media feesOther

THE QYC PLUS-VALUE
We want to know if your project will need guidance or tools to succeed.
Sponsorship letter templateBudget templateInvoice templateParental Approval ConsentPhoto Release FormCommunication plan guidelines to promote your projectSupport to fill out additional funding requestOther

THE APPROVAL

I confirm that all information provided in this Form is true and accurate.I have attached a list of 15 supporters from my community.
 

Full Name

 

Signature

 

Date