Fillable 2021 Application Form for Stream 1 Community Projects

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2021 Application Form for Stream 1 Community Projects

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The 2021 Application Form for Stream 1 Community Projects form is 5 pages long and contains:

  • 1 signature
  • 2 check-boxes
  • 37 other fields

Country of origin: CANADA
File type: PDF

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First Nations Well Being Fund Page 1 of 5
2021 Application Form for Stream 1 – Community Projects
First Nations Well Being Fund
2021 Application Form for Stream 1 – Community Projects
DEADLINE: 11:00 pm, May 30, 2021
Please complete and return the application form and all required attachments by May 30, 2021.
We are providing the form in Word so that you can type your responses directly into the form.
Please simply expand the boxes as required when answering the questions. All questions are
required to be answered.
If you have any questions, contact info@fnps.ca or 604 328 5052 and 604 619 9118.
This program has (2) two funding streams. Please indicate (by crossing out / deleting the
incorrect answer) if you are applying under both streams.
Yes No
SECTION 1: Applicant Information
Name of First Nation or Nation /
Tribal Government:
Contact Person*:
Phone:
Contact Person Position:
Email:
Fax:
Complete Mailing Address:
*Contact person must be an authorized representative of the applicant.
First Nations Well Being Fund Page 2 of 5
2021 Application Form for Stream 1 – Community Projects
SECTION 2: For Nation/Tribal Governments representing multiple First Nations or Regional
Partnerships
1. Nation/Tribal Governments representing multiple First Nations. Please list all First
Nations (i.e. Indian Act bands) that the Nation/Tribal Government is representing as part of
this application. Refer to Section 2 in the Program & Application Guide for eligibility. Please
note: Each First Nation that is part of the application is required to submit a First Nation
Council resolution/Band Council resolution that clearly states their support for the project.
Response:
2. Partnering First Nations. For regional or other group projects, please list all of the
applicants included in this application. Refer to Section 2 in the Program & Application Guide
for eligibility. Please note: Each First Nation who is part of the application is required to
submit a First Nation Council resolution/Band Council resolution that clearly states their
support for the project.
Response:
3. Rationale for applying at the Nation/Tribal Government-level or for applying in
partnership with other First Nations. Please provide a rationale for submitting a
Nation/Tribal Government-level application or for applying in partnership with other First
Nations and describe how this approach will support cost-efficiencies, or other benefits, in
the total grant request.
Response:
Section 3: Project Information
3. Briefly Describe the Project.
Please note: Funding is available for projects that will be completed within 23 months from the date of grant
approval or by July 31, 2023, whichever comes sooner). Refer to Section 4 of the Program & Application Guide
for funding maximums.
Project Title:
First Nations Well Being Fund Page 3 of 5
2021 Application Form for Stream 1 – Community Projects
Proposed start dates:
Proposed end dates:
Total proposed project budget:
Amount of request / Total
grant request:
4. A. Proposed Focus Area / Eligible Project Category. Please indicate (by underlining,
highlighting or bolding) which of the following areas will be the primary focus of the
proposed project:
Food security
Employment
Training and/or Skills-Building
Cultural
Health and Wellness
Families
Children and Youth
Mental Health
Transportation
Other Well-Being Initiatives
B. Please identify any other key priorities (as identified in Together BC) that your proposed
activities will address:
Response:
5. Proposed Activities. Please describe the specific activities you plan to undertake. Refer to
Section 5 of the Program & Application Guide for eligible activities under Stream 1. Please
include information on how community members will be engaged during this project.
Response:
Summarize the community needs and why you want to start this project.
Response:
First Nations Well Being Fund Page 4 of 5
2021 Application Form for Stream 1 – Community Projects
6. Intended Outcomes & Impacts. Outline the overall goals, objectives, and benefits of the
proposed project.
A. How will this project help promote community well-being?
B. How will the community be positively impacted?
C. How will this help reduce poverty at the community and/or Nation level?
D. How many people do you estimate will be impacted by the project?
E. How will this help build capacity within the First Nation?
Response:
7. Proposed Deliverables. What will be the specific deliverables of the proposed project? List
any policies, practices, plans, or documents that will be developed or amended as a result of
your project.
Response:
8. Sustainability. Funding is available for projects that will be completed within 23 months
from the date of grant approval or by July 31, 2023, whichever comes sooner.
Projects that are intended to be ongoing after the First Nations Well Being Fund grant money
has been used will need to seek alternate funding sources.
If the plan is to continue the project or program beyond the dates noted above, please list
other funding source(s):
Response:
9. Evaluation. Describe how you will measure success of the project?
A. Describe the specific performance measures and/or benchmarks that will be used to
measure outcomes.
B. Who will be responsible for the evaluation?
C. How will this information be used?
Response:
First Nations Well Being Fund Page 5 of 5
2021 Application Form for Stream 1 – Community Projects
Section 4: Grant Application Checklist
Please ensure that the following documents are included:
Completed application form;
Detailed project budget that includes a breakdown of all expenses. Please also include
any additional funding sources (if any) for the same project;
First Nation Council resolution/Band Council resolution indicating support for the
project;
For Nation/Tribal Government Applications and Partnership Applications only: each
First Nation that the Nation/Tribal Government represents, and in the case of
partnership applications, each partnering First Nation, must submit a First Nation
Council resolution/Band Council resolution indicating support for the primary
applicant to apply for, receive, and manage the grant funding on their behalf.
Section 5: Submission of Applications
Applications should be submitted as WORD or PDF file(s). Budgets may be provided in Excel.
Please email to: info@fnps.ca with a subject line stating “Well Being Fund Application”
If you choose to submit a mailed copy, please send to:
Attention: First Nations Well Being Fund
First Nations Summit Society: First Nations Public Service Secretariat
Suite #1200 100 Park Royal South
West Vancouver, BC
V7T 1A2
APPLICATIONS ARE DUE MAY 30, 2021
Signature of Applicant:
Date Signed:
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2021 Application Form for Stream 1 Community Projects

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Completed 29 March 2021

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