ECONOMIC DEVELOPMENT INITIATIVE (EDI) (for Francophone Communities) APPLICATION FORM To complete this form, it is important that applicants read and follow the information in the How to Apply section on this site. As indicated in that section, in addition to the form below, applicants need to submit supporting documentation that substantiates information provided in this application form. The following information must be provided in the proposal (along with other documents listed in the Application Checklist. Please remember to save your application periodically to ensure all of your information is saved. We encourage you to contact the designated officer in your region to discuss your application. 1.0 APPLICANT INFORMATION: LEGAL NAME OF APPLICANT: OPERATING NAME: TYPE OF BUSINESS (e.g. main product or service) ADDRESS: KEY OFFICERS/CONTACT PERSON: Mr. Mrs. Ms. Blank Name: Telephone Number: ( ) - E-mail Address: Fax Number: ( ) - PRESIDENT /CHAIR/ MAYOR: Mr. Mrs. Ms. Blank Name: Telephone Number: ( ) - E-mail Address: Fax Number: ( ) - ADMINISTRATION / EXECUTIVE DIRECTOR / GENERAL MANAGER / Mr. Mrs. Ms. Blank CAO Name: Telephone Number: ( ) - E-mail Address: Fax Number: ( ) - TREASURER/BOOKKEEPER: Mr. Mrs. Ms. Blank Name: Telephone Number: ( ) - E-mail Address: Fax Number: ( ) - 1.1 History of the Organization/Association Brief history, including any relevant historical event (e.g. by whom, when, and where organization/association was established; changes in ownership, reorganization, proposal(s) to creditors or bankruptcy). 1.2 Mandate of the Organization/Association As outlined in the legal documents which establish the organization. Enclose copies of documents of incorporation as a not-for-profit corporation. 1.3 Organization/Association Profile Brief description of the organization (number of staff and/or membership, office location (s), its activities, key markets, products/services, catchment area, and other characteristics). 1.4 Officers/Key Employees Identify officers and key employees, indicating their role within the organization, responsibilities, experience and qualifications related to this project. 1.5 Partner Information Identify all contributing partners to this project (financial or otherwise) and describe how they support the project activities. 1.6 Key References Provide name, address and telephone number of key references for the organization/association, including Bank Manager, Accountant, Solicitor and Insurance Agent. 2.0 THE PROJECT: 2.1 Detailed Project Description: Provide a full description of the project. 2.2 Project Objectives: Specify objectives to be achieved by the project and critical issue(s) that the project will resolve. 2.3 Performance Targets: Indicate how the project fits with the strategic objectives of the Economic Development Initiative - Roadmap for Canada’s Linguistic Duality, to support business and economic development initiatives that encourage sustainable growth in Ontario’s Francophone communities by focussing on two strategic priorities (choose one): Community Strategic Planning Business and Economic Development Explain: 2.4 Describe how the project will support the following EDI National objectives (choose one or more of the following): Capacities Built Enterprises Developed Communities Developed Explain: 2.5 For Community Strategic Planning projects, describe the planning process that led to the identification of this project as a priority of the Francophone community. 2.6 For Business and Economic Development projects, indicate how the proposal responds to a priority and need of the Francophone community as identified in a local, regional or provincial strategic and/or community plan (identify the plan). 2.7 Methodology/Timing: Day Month Year Project Start Date: Project Completion Date Identify key workplan activities and project timelines. 2.8 Geographic Location The project will impact the Francophone Communities located in Yes No (please refer to the map provided on the contact list): Northwest region Northeast region Southwest region Southcentral region Southeast region Please identify which Francophone communities this project will impact: The project will have provincial or National impact: Ontario Canada 2.9 Consultant Services: If consulting services will be used, attach: Terms of Reference for the Study (final) List of candidate consulting firms Request for Consultant Proposals (draft or final) Consultant’s Statement of Work (if consultant has been selected) 3.0 COSTS and FINANCING: 3.1 Identify detailed project costs using the project budget template provided on the Web site 3.2 Substantiate detailed project costs provided in the budget information. 3.3 Outline proposed financing arrangements, provide documentation to confirm commitments from funding partner(s) or to indicate the status of such funding requests. 3.4 Using the template provided on the site, provide a cost forecast for the project, clearly indicating expenditure and revenue streams. 3.5 Demonstrate need for assistance. Enclose copies of financial statements for the last two years and the most recent interim financial statement. 3.6 Demonstrate need for cash advance provisions (if applicable). 3.7 Where project generates revenue from operations, state preferred repayment schedule (if applicable). 4.0 ECONOMIC BENEFITS OF THE PROJECT: 4.1 Identify anticipated economic benefits to the Francophone community both during and following the term of the project as it relates to: # jobs created (direct) # jobs maintained (direct) How many are permanent How many are temporary How many are full time How may are part-time or seasonal Explanation: Jobs created Jobs created in a new or an existing business/organization Jobs maintained in an existing business/organization that has Jobs maintained generated sales/had activity (more than one year of operation) in order to maintain a sustainable level of activity A job expected to last five years or more (based on best Permanent Job expectations) Count all jobs created to complete the project (e.g. contractors, staff people, project managers), regardless of how much FedNor contributed or which particular activity was Temporary Job supported. Also, all jobs created, as a result of the project, which are expected to last less than 5 years. Full Time Works 30 hours or more per week/1560 hours or more of work per year Less than 30 hours per week/less than 1560 hours of work per Part-Time or Seasonal year 4.2 Identify other anticipated economic benefits (if applicable). 5.0 IMPACT ON RELATED INITIATIVES: 5.1 Outline any sensitive issues or risks which may be associated with the project, including potential criticism from competitors. 5.2 Indicate whether and how the project is complementary to other related initiatives. 5.3 Identify impacts the project could have on other Ontario and Canadian businesses, organizations, institutions or communities. 6.0 CONSULTATION: 6.1 Identify individuals/organizations which have been consulted on this project (e.g. Francophone organizations involved in the sector, bilingual organizations that serve the Francophone population, Community Futures Development Corporations, Province, Economic Development Officers), and indicate their position. Letters of support may be attached. Please provide telephone number and email address of individuals/organizations which have been consulted on this project. 7. CERTIFICATION Any application not signed by the proper authority of the organization cannot be processed. The undersigned certifies that all information provided to FedNor in support of this request for funding is true and complete, and undertakes to provide any further information that may be required for FedNor to render a decision, in a timely manner. The undersigned also herewith provides consent tor FedNor to make sufficient credit and other enquiries that may be necessary in the evaluation of this request for funding. The undersigned also certifies that no additional funding has been applied for in regards to this project; and, that the Applicant (organization or firm) is current on all obligations to the Government of Canada under agreements for other financial assistance; that the execution of the proposed project will not prevent the applicant from continuing to meet these obligations and from maintaining the economic benefits anticipated by the other agreements; and that these obligations will not preclude the applicant from fulfilling its obligations under the proposed project. Signed this _________ day of ________________, _________. ___________________________________________________ Signature (Officer with signing authority for the Organization) ____________________________________ Title Confidentiality: No commercially confidential information which you submit to us will be disclosed unless otherwise specified by you; required to be released by law; or required by the Minister of Industry to be released to an international or internal trade panel for the purposes of the conduct of a dispute in which Canada is a party or a third party intervener. Information on the federal government's Access to Information Act is available on the following Web site: http://www.justice.gc.ca/eng/pi/atip-aiprp/index.html Any information that you wish to be considered as confidential should be annotated accordingly.
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