CAMECO CREATIVE KIDS NORTHERN CULTURAL FUND GRANT APPLICATION STEP ONE Organizational Profile 1.1 WHO IS APPLYING? Please indicate in the check box below what type of eligible organization you are applying through. If you are not an eligible organization, you have the option to partner with an organization who is an eligible applicant. Any Northern* Municipality Any Northern* First Nation Any Northern* School Registered non profit organization based in Saskatchewan *Northern is defined as organizations that are located within the service area of the Northern Sport, Culture and Recreation District. NAME OF THE ELIGIBLE APPLICANT Non Profit Number (if applicable) 1.2 WHO IS THE PRIMARY CONTACT FOR THIS GRANT APPLICATION? Primary Contact Name: Title Mailing Address City/Town/First Nation Postal Code Home Phone Office Phone e mail Website Fax 1.3 WHO FROM THE APPLYING ORGANIZATION, OTHER THAN THE CONTACT, IS AUTHORIZING THIS APPLICATION? Name of the Organizational Signing Authority Title of Signing Authority Phone e mail By submitting this application, you are authorizing this grant application on behalf of the organization you represent.
1.4 ORGANIZATION STRUCTURE AND MANDATE Please provide a description of your organization s mandate and its structure. 1.5 PAST CULTURAL INVOLVEMENT Please describe the scope of your organization s previous and ongoing CULTURAL programming specific to youth engagement in northern communities. Please list: Activity Location Date 1.6 COMMUNITY REACH Please describe the community(s) your organization serves, its location and the potential number of youth between 4 19 who could be impacted by a program grant: 1.7 Organization Partners Are there any partnerships with other groups, organizations or committees that have committed to support this proposal? Please list in any: Name of partner Describe the partner s contribution to the project Page 2
STEP TWO PROJECT DETAIL 2.1 WHAT TYPE OF SUPPORT ARE YOU APPLYING FOR? The offers two types of funding. Please indicate which type of funding you are applying for be selecting a box below: Program Enhancement Program Enhancement funding is intended to provide opportunities to communities that need a small investment to enhance or broaden the scope of existing cultural, creative or artistic programs for children and youth (up to 1,500). New Program Initiative New Program Initiative funding is intended to support new and emerging creative programs for children and youth in northern communities that address the cultural, creative or artistic needs of northern youth (up to 7,500). 2.2 WHAT IS THE TOTAL AMOUNT REQUEST? Total Amount Requested: 2.3 WHAT IS THE PROJECT NAME/TITLE? (no more than 25 words) Project Name/Title: 2.4 WHAT IS THE PROJECT TIME LINE? Start date (no earlier than 60 days from the grant deadline): End date (no later than 12 months from the project start date) (D/M/YEAR) (D/M/YEAR) Page 3
STEP 3 PROJECT DESCRIPTION 3.1 PROJECT DESCRIPTION In the space provided below, please describe the project. For New Program Initiative applications, provide a description of what the new initiative is. Please identify if possible who will be working with the youth (artists, elders, culture workers) and what activity the youth will be engaged in. If this is a Program Enhancement application, please describe the existing program and specify what the program enhancement support is for. Page 4
3.2 PROJECT SCOPE and STAGES OF DELIVERY In the table below, estimate what activities will be taking place with attention to dates and location. If an activity is a reoccurring event, it can be recorded like this: (every Wednesday afterschool, in the school gym, December 2014 February 2015) ACTIVITY and LOCATION (example: dance workshop in the school gym) Estimated number of youth participating (estimated number of youth participating per activity) DATE (d/m/y) Total number of activities: Total number of youth participating 3.3 VOLUNTEERS AND PARTICIPANTS Please describe what contribution volunteers will have with this project and estimate how many volunteers will be engaged Number of volunteers 3.3 PROJECT IMPACT Please describe how this program will enhance the cultural opportunities for youth aged 4 19 with financial barriers to participation in your community Page 5
STEP 4 BUDGET CAMECO CREATIVE KIDS NORTHERN CULTURAL FUND *KEEP A COPY OF THIS BUDGET FORM FOR PURPOSES OF FOLLOW UP REPORTING 4.1 PROJECT REVENUE Please list all relevant cash income committed to support this project. Only eligible expenses (outlined throughout the budget form) can be considered. If Cameco Creative Kids Northern Cultural Fund is the only source of income, leave the other rows empty. Please do not list any in kind (non cash) income. List sources of financial support that are UNCONFIRMED: Cameco Creative Kids Northern Fund Request List sources of financial support that are CONFIRMED: Total Income (The total income includes both confirmed and unconfirmed amounts. This total must be equal to the total proposed project expense) Page 6
4.2 EXPENSES WAGES Please describe any applicable wages for artists, elders and/or cultural resource peoples Total Wages Expense: MATERIAL/EQUIPMENT Please describe support materials required and show calculations for the proposed costs. Total Material Expense Note: A maximum of 10% of the total grant award can be applied towards nutrition related expenses if these costs can be directly attributed to the cultural activity TRAVEL Travel costs are not a priority for this grant, but Travel expenses for service providers and program participants ARE ELIGIBLE so long as the activity takes place is in the north. Total Travel Expense Page 7
FACILITY Facility costs are not a priority for this grant, and an IN KIND contribution of space is recommended. However, consideration for Facility costs can be reviewed for exceptional cases Total Facility Expense ADVERTISING Total Advertising Expense A maximum of 10% of the total funding request can be used for promotion/adverting (example, a 7500 request can be eligible for 750 in advertising). Please describe advertising costs if any. Exceptions to this rule can be made for Project Enhancement applicants only. 4.3 TOTAL BUDGET EXPENSES AND REVENUES Please add all project expenses. Total Wages Expense Total Material Expense Total Travel Expense Total Facility Expense Total Advertising Expense **TOTAL Project EXPENSE: **TOTAL Project INCOME **The Total Expense and Total Project Income be EQUAL and have a balance of zero. Please check the box if you do not want to receive intermittent information on Creative Kids or SaskCulture Inc. programs and services. Please let us know how you heard of this (ie radio, newspaper, facebook etc..). Page 8