PAW 3845614 (2021-2022)
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PROTECTED A (When Completed)
Note This template is for use by the following departments: Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC) and Indigenous Services Canada (ISC).
Privacy Statement
This statement explains the purposes for the collection and use of personal information. Only information needed to respond to program requirements will be requested. Collection and use of personal information are in accordance with the Privacy Act (https:// In some cases, information may be disclosed without your consent pursuant to subsection 8(2) of the Privacy Act. The collection and use of your personal information for the Governance Capacity Programs are
authorized by the Department of Indigenous Services Act (S.C. 2019, c. 29, s. 336) (, the Department of Crown-Indigenous Relations and Northern Affairs Act (S.C. 2019, c. 29, s. 337) (https://laws-lois. and s. 122 (1), 123 (1) and 124 (1) of the Financial Administration Act ( and required for your participation. We will use your personal information for evaluation
purposes in order to respond to your Capacity Development Plan. The information collected is described in Personal Information Bank AANDC PPU 300 (, and will be retained for a period of
30 years and then the records are transferred to the Library and Archives Canada. As stated in the Privacy Act, you have the right to access your personal information and request changes to incorrect information. Contact the departmental Public Enquiries
Contact Centre at 1-800-567-9604 to notify us about incorrect information. For more information on privacy issues and the Privacy Act in general, you may consult the Privacy Commissioner at 1-800-282-1376.
Planning Horizon: Year 1 (YYYY) Year 5 (YYYY)
Recipient Name
Recipient Number
Given Name Family Name Title Telephone Number Email Address
Plan Information
Identify your community's capacity needs and provide a summary of the projects which could address each need. Include information sufficient for departmental officials to evaluate the proposed project against program objectives, criteria on
eligibility and eligible expenditures. Provide a narrative which describes the following: Capacity Needs; Fiscal Year; Priority; Capacity Development Projects; Description/Objectives; Start and End Date of Each Project and Contact Person; Detailed
Costs; Indicators; and Expected Outcomes. The following is a suggested format for your capacity development plan; you may also choose to submit another format so long as the above-mentioned criteria are captured.
Identify Capacity Needs Fiscal Year Priority Capacity Development Projects Description/Objectives
Start Date
End Date
(YYYYMMDD) Contact Person Detailed Costs Indicators Expected Outcomes
Supporting Documents (if applicable)
Title Submission Method
The information provided is accurate to the best of my knowledge.
Given Name Family Name Title