Instructions Print Form
Funding Request Summary
Western Economic Diversification Canada (WD)
Full Legal Name of Applicant Organization: _____________________________________________________
Email: _________________________________ Website Address: ___________________________________
Contact Person/Title: ________________________________________________________________________
Business Number: _________________________________________________
If alternate number is used, indicate the type: _________________________________________ (see instructions for more detail)
Corporate Status (check all that apply):
Incorporated federally: Date of Incorporation: ______________________
Incorporated provincially: in the province of: _________ Date of Incorporation: ______________________
Not For Profit: Co-operative: Other: __________________________________(describe status)
If not already provided, please attach a 1-2 page summary of the proposal. A WD official will be in touch with you within 12
business days and a more detailed proposal may be required if the project fits with departmental priorities. It is strongly
recommended that you read the general requirements for proposals at http://www.wd.gc.ca/eng/10430.asp before filing
Amount ($): _____________________ Total Project Cost ($): ____________________
Other sources of proposed funding (dollar value & name):
On behalf of the Applicant Organization, I hereby acknowledge and agree that:
This funding request and the attached proposal summary do not constitute a commitment from WD for financial
Project costs incurred by the Applicant Organization in the absence of a signed funding agreement with WD are incurred
at the sole risk of the Applicant Organization and that any such costs may not be considered eligible for WD assistance.
Any person who has been lobbying on behalf of the Applicant Organization to obtain a contribution as a result of this
application is registered pursuant to the Lobbyists Registration Act and was registered pursuant to that Act at the time the
The Applicant Organization has not, nor has any other person, corporation or organization, directly or indirectly paid or
agreed to pay any person to solicit a contribution arising as a result of this application for a commission, contingency fee
or any other consideration dependent on the execution of an Agreement or the payment of any contribution arising as a
result of this application.
All information provided by the Applicant Organization to WD will be treated in accordance with the Access to Information Act
and the Privacy Act. These federal laws govern, protect and limit the collection, use and disclosure of personal, financial and
technical information by federal government departments and agencies. In addition to and notwithstanding the above, WD
reserves the right to make information relating to any contribution resulting from this application available to the public, including
providing limited information on a public website as part of a list of all projects funded by WD. The Applicant Organization
hereby represents that it has the authority to consent and consents to the information being made available to the public.
I also agree to allow WD to share information contained in this form, attached documents, and subsequent project information
with other government departments as part of WD’s due diligence and program referral activities, subject to the Access to
Information Act and the Privacy Act noted above.
Name: _______________________________ Title: ________________________ of Authorized Official of the Applicant Organization:
Signature: _____________________________ Date: ________________________
WD office use only – Project No.:____________________
Aussi disponible en français.
Funding Request Summary
General Information and Instructions
Before submitting a funding request it is strongly recommended that the applicant contact the nearest WD office and review WD’s
priorities at http://www.wd.gc.ca/eng/59.asp to ensure the funding request fits within WD priorities.
The Funding Request Summary form must be completed in full, and includes an attached 1 – 2 page summary of the proposal, as indicated
in the “Proposal Summary” section of the form. Further information on the 1 – 2 page proposal is available online at
Completed forms can be mailed or faxed to one of the WD offices listed below:
WD British Columbia WD Saskatchewan
700 - 333 Seymour Street P.O. Box 2025
Vancouver, BC V6B 5G9 Suite 601, 119 4th Avenue South
Phone: (604) 666-6256 Saskatoon, SK S7K 3S7
Toll Free: 1 888 338-WEST (9378) Phone: (306) 975-4373
Fax: (604) 666-2353 Toll Free: 1 888 338-WEST (9378)
Fax: (306) 975-5484
WD Alberta WD Manitoba
Suite 1500, Canada Place P.O. Box 777
9700 Jasper Avenue Suite 712, The Cargill Building
Edmonton, AB T5J 4H7 240 Graham Avenue
Phone: (780) 495-4164 Winnipeg, MB R3C 2L4
Toll Free: 1 888 338-WEST (9378) Phone: (204) 983-4472
Fax: (780) 495-4557 Toll Free: 1 888 338-WEST (9378)
Fax: (204) 983-3852
First Box: Enter the required information in the space provided. Definitions of the requirements are below:
Full Legal name: The legal name of the applicant organization, as shown on the certificate of incorporation/registration.
Address: The location at which the applicant organization receives its mail (mailing address.).
Phone / Fax: The phone number at which the applicant organization can be contacted / the fax number at which the applicant organization
will receive faxes.
E-mail: the primary e-mail at which the applicant organization can be contacted
Website address: (if available) the organizations website address
Contact Person / title: The full name and title of the individual who will be the primary contact.
Business Number (BN): The unique Business Number assigned to the applicant organization by the Canada Revenue Agency.
• Recognizing the BN
o The Business Number consists of a total of 15 characters: 9 digits, 2 letters, and 4 more digits. For example 123456789
o Further information about the Business Number is available at: http://www.cra-arc.gc.ca/tax/business/topics/bn/works-
• Obtaining a BN
o A Business Number must be obtained through the Canada Revenue Agency.
o Information on obtaining a Business Number is available at: http://www.cra-arc.gc.ca/tax/business/topics/bn/menu-
• Alternate number
o In the special circumstance that the applicant organization is unable to obtain / does not require a business number, an
alternate unique identification number may be used. (E.g., a First Nations Band Number (3 digits or a university)
o If an alternate number is used, put it in the spaces provided for the Business Number, and indicate the type in the space
Indicate the legal corporate status and type of the applicant organization by checking all boxes that apply. If incorporated, indicate the
date incorporated in the space provided. If incorporated provincially, indicate the province of incorporation in the space provided.
The definitions of the options available are below:
• Incorporated: An organization that has formed into a legal corporation by completing the required legal procedures
o Federal: The organization has the rights to operate under its corporate name throughout all of Canada
o Provincial: The organization has the rights to operate under its corporate name in the province in which it is incorporated
• Un-incorporated: An organization that is not legally incorporated, that is, it has not formed into a legal corporation.
• Not for Profit: An incorporated organization which exists for educational or charitable reasons, and from which its members,
employees, shareholders, or trustees do not benefit financially.
• Co-Operative: A not for profit organization formed by a group or organization who themselves own and operate the
organization, for the mutual benefit of the members.
• Other: Define the type if this option is chosen
Attach (if not already provided) a 1 –2 page summary of the proposal. Further information on the general requirements for proposals is
available at: http://www.wd.gc.ca/eng/10430.asp.
If the applicant organization already has a full proposal completed, they may include this instead of a proposal summary. (That is, they are
not required to create an additional 1-2 page summary.)
Indicate here general funding information in the space provided. Definitions of the requirements are below.
• Amount: Enter the total amount of funding requested from WD.
• Total project cost: Enter the cost of the entire project – not just the portion that WD may be funding
• Other sources of proposed funding: Identify all additional sources of funding, and indicate the proposed funding amount.
After reading and understanding the section, fill in the required information, sign, and date. Further explanation of the requirements is
• Name and Title of Authorized Official of the Applicant Organization: fill in the name and title of the member of the
organization with signing power / the authority to enter into an agreement. (This person may be different from the Contact
• Signature: this is where the Authorized Official of the Applicant Organization signs
• Date: the Authorized Official of the Applicant Organization enters the date at which he/she signed the document
WD office use only – project number:
Do not enter any information in this field. It is for internal WD office use.
For additional information, proponents are encouraged to contact the nearest regional WD office. The regional offices are listed on page 1
of this document.