COMMUNITY MOBILIZATION PROGRAM

Protected when completed National Crime Prevention Centre Application Form Crime Prevention Action Fund The Crime Prevention Action Fund (CPAF) provides time-limited grant and contribution funding that supports crime prevention initiatives in communities, large and small. It aims to build partnerships between sectors such as policing, community health and voluntary and private sectors to enhance community capacity to prevent crime through social development. It is a federal program that is delivered regionally in partnerships with the provincial and territorial governments, and nationally for those projects involving more than one jurisdiction. The CPAF is a part of the National Crime Prevention Strategy (NCPS). The NCPS aims to increase sustainable crime prevention activities, develop and share knowledge, and coordinate multi-level support for crime prevention. Community-based organizations play a key role in the NCPS. People working in these organizations know their communities best; they are closer to the problems and the solutions. The CPAF helps these community-based organizations prevent crime through projects that address interrelated social issues in a unified, effective manner. Objectives of the CPAF The objectives of the CPAF are to:     Enhance the capacity of diverse communities to decrease risk factors and increase protective factors related to crime and victimization Promote cross-sector collaboration in crime prevention, with particular emphasis on engaging the voluntary and private sectors and participating in multi-partner initiatives Develop, disseminate and transfer information, tools and resources, including best practices and evidence of what works in crime prevention Support the development of comprehensive community initiatives to address crime and victimization issues Organizations should ensure that project proposals are clear and the objectives and outcomes are achievable over the defined period of time. If the application is not complete, your organization may be contacted and asked to provide the missing information. Funding for CPAF projects is limited. Projects that demonstrate they can best meet the objectives of the CPAF are given priority. Before applying, we encourage you to read the CPAF Overview document and contact a program officer at the National Crime Prevention Centre (NCPC) to obtain as much information as possible before you begin. We are available to advise you about the eligibility of your organization and initiative, answer your questions and link you with others doing similar work, if necessary. Additionally, we have created a series of fact sheets and guidance documents for crime prevention projects, which can be found in the Applicant’s Guide. They are designed to help you prepare a solid application. The titles include:      Budget Project Planning and Evaluation Sustainability for Crime Prevention Partnerships Risk and Protective Factors All of the above mentioned documents are available online or in print through the NCPC. For additional documentation or information consult: www.publicsafety.gc.ca/ncpc Or, phone the NCPC: 1-877-302-6272 Steps for application Once your community has had an opportunity to explore what they wish to accomplish you may find these steps useful. Step 1 Obtain and read the above-mentioned guidance documents and fact sheets, which can be found in the Applicant’s Guide. Step 2 Develop your project plan, following the document entitled Project Planning and Evaluation, which can be found in the Applicant’s Guide. Once you have completed your project plan, the rest of the application will be easier to fill in! Step 3 Develop a detailed budget, following the document entitled Budget, which can be found in the Applicant’s Guide. Step 4 Duly complete and sign this application form. Assemble all required supporting documents, using the checklist at the end of this application form. Step 5 Submit one electronic and one signed hard copy of your application. For further information on the funding programs of the National Crime Prevention Centre (NCPC) and for contact information for your region, please visit www.publicsafety.gc.ca/ncpc or call the NCPC: 1-877-302-6272. Applicant information 1. 2. In which official language do you wish to communicate? English [] French [] Project title: (If applicable, please indicate if this is a subsequent Phase to another project) 3. Sponsor organization: Organization Name: Street Address: Suite/Apartment: City/Town: Province/Territory: Postal code: Website: 4. Please identify the GST or Canada Revenue Agency Business Number (if applicable): GST #: CRA Business #: 5. Project contact person: First & last name: Position: Telephone: Fax: E-mail: 6. Mailing address: Organization name: Street address: Suite/Apartment: City/Town: Province/Territory: Postal code: 7. Project location: (If different from mailing address above, please indicate where the project is being delivered or identify where the project is being administered.) Street address: Suite/Apartment: City/Town: Province/Territory: Postal code: 8. Please indicate the duration of the project. Please note: Start dates should be at least 4-6 months after the application deadline to allow time to review and make funding decisions. Start date: (d/m/y) End date: (d/m/y) Project length: months About your organization 9. Tell us about your organization. (a) What is the mandate of your organization? (b) Provide a brief summary of your organization, e.g., What is the scope of your organization? What do you do day-to-day? (c) Who benefits from your services? 9. Tell us about your organization. Include the names and addresses of your organization’s board of directors or governing body. If your organization is an ad-hoc committee, please provide the names and contact information of all of the committee members. If your organization is a coalition, please provide the organization’s representatives. (d) Who is involved in your organization? (e) How long has your organization been in operation? (f) If your organization is incorporated, please indicate the date of incorporation: (d/m/y) Please note: You do not need to be incorporated to receive funding from the NCPC. If your organization is incorporated, please attach a copy of your articles of incorporation or certificate of incorporation along with a copy of your most recent audited financial statement and business/strategic plan describing your organization’s planned activities and programs for the current year. 10. At which level is your organization active? (Check only those that apply) Local ............................................................................................................................................. Regional (an area of a province/territory) ...................................................................................... Provincial/Territorial ....................................................................................................................... Inter-Provincial/Territorial .............................................................................................................. National ......................................................................................................................................... International ................................................................................................................................... [] [] [] [] [] [] 11. Have you previously received funding from the National Crime Prevention Centre? No Yes (If yes, please respond to questions (a), (b) and (c) below.) [] [] (a) Sponsoring organization name (if different): (b) Project title(s) and/or file numbers: (c) Please describe if this project is associated with any of the previously funded projects (e.g., this is “phase 2” and will put into action the project plan created with the previous funding). 12. Which category best describes your organization? (Check only one) Aboriginal agencies or organizations (not government or Tribal/Band Council) ......................... Aboriginal government or Tribal/Band Council ............................................................................. Arts and Culture ............................................................................................................................ Business (Chamber of Commerce, etc.)....................................................................................... Community, social or voluntary services (family services, etc.) ................................................... Criminal justice, Corrections, Police ............................................................................................. Education ...................................................................................................................................... Employment .................................................................................................................................. Government – local, municipal...................................................................................................... Government – provincial or territorial .......................................................................................... Housing Services .......................................................................................................................... Health ........................................................................................................................................... Parks & recreation ........................................................................................................................ Religious/Faith .............................................................................................................................. Service Clubs (Rotary Club, etc.).................................................................................................. Other (please specify): .................................................................................................................. [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] 13. What gives you confidence that your organization will be able to lead and manage this project successfully?  What information, skills and experience does your organization bring to the project?  What relationship does your organization have with the community?  How will your organization get the community involved?  What are your successes in working on other projects? About your project 14. Which CPAF goal(s) will this project clearly and directly address? (Check only those that apply.) Enhance the capacities of diverse communities to decrease risk factors and increase protective factors related to crime and victimization ....................................................................................... Promote cross-sectoral collaboration in crime prevention, with particular emphasis on engaging the voluntary and private sectors and participating in horizontal initiatives ...................................... Develop, disseminate and transfer information, tools and resources, including best practices and evidence of what works in crime prevention ..................................................................................... Support the development of comprehensive community initiatives to address crime and victimization issues. ......................................................................................................................... [] [] [] [] 15. What is the main project idea? Briefly describe the main project idea, the overall purpose and why you choose to use this approach. (Maximum 500 words) 16. What is (are) the main crime and victimization issue(s) that this project will focus on? A crime or victimization issue is a crime-related problem that has a negative impact on the safety and well-being of individuals. For further information, please refer to the fact sheet entitled Risk and Protective Factors, which can be found in the Applicant’s Guide. You will want to consult research on the issue, talk to other people affected by the issue, and use your own experience in deciding which risk or protective factors your project will address. 17. How do you know there is a need for this project? Describe what is happening with respect to crime, victimization or fear of crime and why it is important to carry out this project. Please include information on current crime and victimization statistics and/or information from community needs assessments, and other supporting documents. 18. Please identify the main risk factors or protective factors that your project will directly address. Please read the fact sheet entitled Risk and Protective Factors, which can be found in the Applicant’s Guide, in preparation for responding to this question and limit your response to include no more than five (5) main risk factors or protective factors. 19. How does addressing these risk and protective factors contribute to increased community safety? 20. At what level will your project activities focus on addressing risk or protective factors? If you think about what influences crime and victimization, you’ll notice that underlying factors are found at many “levels.” For further information, please reference the fact sheet entitled Risk and Protective Factors, which can be found in the Applicant’s Guide. (Check only those that are most reflective of your project) Individual .......................................................................................................................................... Family/Peer ...................................................................................................................................... Community/School/Workplace ......................................................................................................... Societal ............................................................................................................................................ [] [] [] [] 21. Please indicate what group or groups will benefit the most from this project. e.g., children; girls; Inuit elders; ethno-cultural communities; etc. 22. Please indicate the age of the main priority group that will be involved. e.g., Young children (0-5); All Children (0-12); Youth (13-17); Adults (31-54); Seniors (55 and over), etc. 23. Please describe how you plan to engage, recruit and/or select members of the main priority group to participate in the project activities. e.g., How many people do you wish to participate, how will they find out about the project and what are the recruitment and/or selection criteria that you will use? 24. Please describe when and how participants of the main priority group have been involved in project planning so far, and how they will continue to be involved throughout the project in the management, delivery and/or evaluation of this project. e.g., part of activity planning group, board representative, leading group sessions, developing evaluation strategy, etc. 25. Indicate the gender of the main priority group. Males ............................................................................................................................................ Females ........................................................................................................................................ Both Males and Females .............................................................................................................. [] [] [] 26. Will your project adopt a gendered approach? A gendered approach recognizes that males and females may have different needs or be affected differently by the same interventions or activities, and allows for this in the design of the project and in the analysis of the results. Yes ................................................................................................................................................ No ................................................................................................................................................. If yes, please provide additional information. [] [] 27. Please indicate if your project will take place in any of the following locations: (Check only those that are most reflective of where your project will take place) Aboriginal community off-reserve .................................................................................................. Aboriginal community on-reserve .................................................................................................. Inuit community Métis settlement ........................................................................................................................ ........................................................................................................................ [] [] [] [] [] [] [] [] [] [] [] Isolated/remote community ........................................................................................................... Local/community ....................................................................................................................... Inner-city community...................................................................................................................... Northern community ...................................................................................................................... Province/Territory-wide .................................................................................................................. National (across Canada) .............................................................................................................. Other .............................................................................................................................................. Project goals and planning 28. What is/are the overall goal(s) of the project? e.g., To increase prosocial behaviours and attitudes among youth aged 12 to 18 years. 29. Provide a project plan, showing how you will achieve your goal(s). A good project plan clearly identifies the outcomes that, in turn, combine to achieve your goals. A welldeveloped project plan will also serve as the first part of the evaluation plan. Please identify the tangible outcomes for the project. Then fill in the specific details of what you will do to arrive at those outcomes, using the project planning matrix example below. Please read the guidance document entitled Project Planning and Evaluation, which can be found in the Applicant’s Guide. It provides a standard framework for planning and will help you build a solid project proposal. Project planning matrix example Objective(s): Inputs What resources are needed to make your project operate? (e.g., equipment, project materials, transportation, staff resources, etc.) Activities What activities will take place during the project? (e.g., development of program materials, needs assessments, consultations with community agencies, workshops, etc.) Outputs Outcomes How many and what kind What will happen as a of products and/or result of your project? services will be generated from these activities? (e.g., number of participants, training sessions or events/ meetings, advertising, brochures, pamphlets, DVD/video, website, etc.) (e.g., reduction in bullying, improved school performance by youth, etc). 30. How will you evaluate the success of your project? What proposed source/method will be used to gather the information? For definitions and further information on how to complete the following evaluation matrix, refer to the guidance document entitled Project Planning and Evaluation, which can be found in the Applicant’s Guide. Remember that you may not be able to measure long-term outcomes so choose only those that you will be able to assess. Evaluation Matrix example Objective(s): Outcomes Indicators Sources/Methods What proposed source/method will be used to gather the information? What will happen as a How will you know that result of your project? the project is achieving its objectives and outcomes? (e.g., reduction in bullying, improved school performance by youth, etc.) (e.g., initial increase in the number of reported incidents, followed by a corresponding reduction in number of bullying incidents, higher grades for at-risk students, etc.) Source of information: (e.g., children, parents, teachers, etc.) Tools / instruments: (e.g., log book, questionnaire, voice recorder, school records) Frequency of collection: (e.g., start and end of project, every week, every month, six months after project) Partners and stakeholders 31. How will you involve other partners or stakeholders in the project? * Identify below the name of the organization, the area that would best describe the partner/stakeholder organization (refer to list below) and how this organization will add value to your project through their role and contribution to the project. For definitions on the various roles of partners, please refer to the fact sheet entitled Partnerships, which can be found in the Applicant’s Guide. Role: Communication, Cooperation, Coordination and/or Collaboration Name of Partner Organization Area (Indicate letter from list below) Contribution Example: St. Mary’s Community Health Centre L Collaboration Will provide nurse volunteers; talk to schools about program; provide space for training of mentors; provide paper & supplies; will share equal responsibility for running the project. A. B. C. D. E. F. G. H. Aboriginal agencies or organizations Aboriginal government (Tribal/Band Council) Arts and Culture Business (Chamber of Commerce, etc.) Community, social or voluntary services (family services, etc.) Criminal justice/Corrections/Police Education Employment I. J. K. L. M. N. O. P. Government – local, municipal Government – provincial or territorial Government - federal Health Housing services Religious/Faith Service clubs (Rotary Club, etc) Other – Please specify: *Note: Please provide a minimum of three (3) letters of support from partners or stakeholders involved in the project. This is a mandatory requirement. Each letter of support from partners or stakeholders should provide:    Organization information (including name of partner organization, agency, group or association; and name, phone number and mailing address of contact person) Description of how the project partner or stakeholder has been involved so far and what their planned involvement in the project will be in the future, including funding or donations, if applicable Description of how the supporting partner organization, agency, group or association see the benefit of the project Budget 32. Please provide a detailed budget for the project. For multi-year funding, please include a separate budget for each year. Refer to the guidance document entitled Budget, which can be found in the Applicant’s Guide. It explains all eligible project costs and provides definitions, explanations, and a detailed example of how to complete the following chart. Using the headings outlined below, you may prepare your budget in Excel, Word or WordPerfect, and attach it to this application, or you may fill in the form below. Please specify the breakdown for each item. For example: Personnel: Project Manager -- 40 hrs/wk X $20/hr X 10 wks Transportation: Bus Passes for volunteers -- 25 passes X $50 /month X 2 months Rent/Utilities: Meeting rooms -- $50/hr X 400 hrs / Phone - $35/month X 12 months Project budget Contributions from other sources Budget item (w/breakdown) Financial contribution ($) *(Name of organization making contribution) In-kind donation *(Name of organization making contribution) NCPC $ requested Budget totals Confirmed Personnel Transportation Unconfirmed Confirmed Unconfirmed Equipment (cannot represent more than 10% of total budget) Materials/Supplies Rent/Utilities Evaluation (recommended 10% of project budget) Other (please specify any additional budget items and provide a breakdown if applicable) Totals Sustainability 33. Tell us what your organization will do to increase the chances that your project, or some of the work of the project, will continue after CPAF funding ends. For information on what to consider when developing your plan for sustainable action, please refer to the fact sheet entitled Sustainability, which can be found in the Applicant’s Guide. Knowledge Sharing 34. Tell us how you plan to share the results of your project with local participants and others.   With whom do you plan to share information? e.g., general public, police, social workers, teachers, community crime prevention organizations, educators, etc. What information do you plan to share? e.g., feedback from participants, partners, public; information about who you reached through the project; lessons learned such as how to do this type of project, what went well, what did not go well; products, tools or resources produced; results, findings, statistics, information/data from project; Successes / achievements; models or best practices; training, etc. How do you plan to share information? e.g., conferences, meetings or workshops, newsletter, local community/neighbourhood/city newspaper, radio or television media, website, etc.  Declaration As a representative of the sponsoring organization, I declare that:  The information in this application is complete and accurate.  The application is made on behalf of the organization named below with its full knowledge and consent.  The sponsoring organization is responsible for its own debts and the NCPC will not be asked to pay any debts.  The sponsoring organization has disclosed any actual or potential conflict of interest, including involvement of any former public servants who fall under the Post-Employment Code.  If approved for funding, the sponsoring organization agrees to use these funds for the activities identified in this application. No changes will be made to this project without the prior approval of the NCPC.  If approved for funding, the sponsoring organization will follow ethical and standard procedures in the hiring and supervision of personnel involved in this project.  If approved for funding, the sponsoring organization will complete a “Final Project Report” using the form provided by the NCPC. The sponsoring organization will fulfill reporting requirements detailed in a signed Agreement, including project financial and activity reports.  If approved for funding the recipient understands and agrees to fully participate in a NCPS evaluation or audit of the project (if required). The purpose of the evaluation will be to determine if the project met its goals and objectives, the objectives of the CPAF and NCPS and whether the activities funded were an effective way of preventing crime. Further, I am aware that:  As part of the application assessment process, information contained in this application will be shared with CPAF review committees.  If this project is approved for funding, the NCPC will require copies of any tools, resources and materials produced.  The sponsoring organization will follow the guidelines provided by the NCPC to acknowledge funding by the NCPC, an initiative of the Government of Canada, on all materials produced by the project.  The sponsoring organization agrees to respect and adhere to the Canadian Human Rights Act (a copy of which can be found at www.chrc-ccdp.ca) and to treat fairly and respectfully all persons in the community where the project will take place.  The recipient must demonstrate that the specific needs of the official language minority community (i.e., Francophones outside of Québec and Anglophones in Québec) have been taken into consideration, where circumstances justify or warrant. Project signing authority: Name and title: Signature Date (DD/MM/YYYY) Application checklist For your own verification purposes and for efficient processing, please check off all of the supporting documents that you have included with this application. Three (3) letters of support from partners or stakeholders* .......................................................... Articles of incorporation or certificate of incorporation (if your organization is incorporated) ........ Audited financial statements (most recent) ................................................................................... Annual report ................................................................................................................................. Statistics ........................................................................................................................................ Business or strategic plan ............................................................................................................. News articles, publications ............................................................................................................ Other .............................................................................................................................................. (Please specify) [] [] [] [] [] [] [] [] *Note: You must provide a minimum of three (3) letters of support from partners or stakeholders involved in the project. This is a mandatory requirement. Each letter of support from partners or stakeholders should provide:    Organization information (including name of partner organization, agency, group or association; and name, phone number and mailing address of contact person) Description of how the project partner or stakeholder has been involved so far and what their planned involvement in the project will be in the future, including funding or donations, if applicable Description of how the supporting partner organization, agency, group or association see the benefit of the project Submit one electronic and one signed hard copy of your application. If your project is national in scope or crosses provincial jurisdictions, you will send your application to the NCPC national office in Ottawa, Ontario. If your project is specific to your community, municipality, province or territory, you will send your application to your provincial or territorial office. For further information on the funding programs of the National Crime Prevention Centre (NCPC) and for contact information for your region, please visit www.publicsafety.gc.ca/ncpc or call the NCPC: 1-877-302-6272.