Form PAW5664860 "Family Violence Prevention Program (Fvpp) Prevention Project Proposal" - Canada

ADVERTISEMENT
ADVERTISEMENT

Download Form PAW5664860 "Family Violence Prevention Program (Fvpp) Prevention Project Proposal" - Canada

205 times
Rate (4.6 / 5) 10 votes
PAW 5664860 (2019-2020)
Page 1 of 2
FAMILY VIOLENCE PREVENTION PROGRAM (FVPP)
PREVENTION PROJECT PROPOSAL
Privacy Act Statement
This statement outlines the purposes for the collection and use of personal information. Only information needed to respond to program requirements will be
requested. Collection, use, and disclosure of personal information are in accordance with the
Privacy
Act. In some cases, information may be disclosed without
your consent pursuant to subsection 8(2) of the Privacy Act. The authority to collect and use personal information for the Family Violence Prevention Sub-
Program within Social Development is derived from
OIC
2017-1464, as well as from annual Appropriation Acts granting authority to the Government to spend
funds on programs. We will use personal information for administrating, assessing and determining eligibility for the program to which you are applying and for
reporting aggregated program results. We may share the personal information you provide us with as outlined under
AANDC PPU
210, detailed at
Info Source
(http://www.aadnc-aandc.gc.ca/eng/1100100011039/1100100011040). The information collected will be retained for a period of five years, then transferred to
Library and Archives Canada. As stated in the Privacy Act, you have the right to access the personal information you give us and request changes to incorrect
information. Contact your
Regional Office
(http://www.aadnc-aandc.gc.ca/eng/1100100016936/1100100016940) to notify us about incorrect information or
contact the Public Enquiries Contact Centre by phone at 1-800-567-9604 for general enquiries. For more information on privacy issues and the Privacy Act in
general, you may consult the Privacy Commissioner at 1-800-282-1376.
Identification
Recipient Name
Recipient Number
Mailing Address (Number/Street/Apartment/P.O. Box)
City/Town
Province/Territory
Postal Code
Contact
Given Name
Family Name
Title
Telephone Number
Facsimile Number
Email Address
Project Information
Project Name
Project Start Date
Project Completion Date
(YYYYMMDD):
(YYYYMMDD):
Is this a new or continuing project?
New
Continuing
Where will the project be delivered?
On-Reserve
Off-Reserve
Budget Information
Item
Description
Amount ($)
Equipment and Supplies
Information, Documents, Web
Facility Rentals
Travel
Professional Fees (Facilitator/Trainer)
Administration Costs (Maximum 15%)
Other (i.e. Salaries and Wages, if applicable)
Total Funding Requested from Indigenous Services Canada
PAW 5664860 (2019-2020)
Page 1 of 2
FAMILY VIOLENCE PREVENTION PROGRAM (FVPP)
PREVENTION PROJECT PROPOSAL
Privacy Act Statement
This statement outlines the purposes for the collection and use of personal information. Only information needed to respond to program requirements will be
requested. Collection, use, and disclosure of personal information are in accordance with the
Privacy
Act. In some cases, information may be disclosed without
your consent pursuant to subsection 8(2) of the Privacy Act. The authority to collect and use personal information for the Family Violence Prevention Sub-
Program within Social Development is derived from
OIC
2017-1464, as well as from annual Appropriation Acts granting authority to the Government to spend
funds on programs. We will use personal information for administrating, assessing and determining eligibility for the program to which you are applying and for
reporting aggregated program results. We may share the personal information you provide us with as outlined under
AANDC PPU
210, detailed at
Info Source
(http://www.aadnc-aandc.gc.ca/eng/1100100011039/1100100011040). The information collected will be retained for a period of five years, then transferred to
Library and Archives Canada. As stated in the Privacy Act, you have the right to access the personal information you give us and request changes to incorrect
information. Contact your
Regional Office
(http://www.aadnc-aandc.gc.ca/eng/1100100016936/1100100016940) to notify us about incorrect information or
contact the Public Enquiries Contact Centre by phone at 1-800-567-9604 for general enquiries. For more information on privacy issues and the Privacy Act in
general, you may consult the Privacy Commissioner at 1-800-282-1376.
Identification
Recipient Name
Recipient Number
Mailing Address (Number/Street/Apartment/P.O. Box)
City/Town
Province/Territory
Postal Code
Contact
Given Name
Family Name
Title
Telephone Number
Facsimile Number
Email Address
Project Information
Project Name
Project Start Date
Project Completion Date
(YYYYMMDD):
(YYYYMMDD):
Is this a new or continuing project?
New
Continuing
Where will the project be delivered?
On-Reserve
Off-Reserve
Budget Information
Item
Description
Amount ($)
Equipment and Supplies
Information, Documents, Web
Facility Rentals
Travel
Professional Fees (Facilitator/Trainer)
Administration Costs (Maximum 15%)
Other (i.e. Salaries and Wages, if applicable)
Total Funding Requested from Indigenous Services Canada
PAW 5664860 (2019-2020)
Page 2 of 2
Project
Project Description
Need, Activities, Expected Results
Target Audience:
Women
Men
Children
Families
LGBTQ/Two-Spirited
Other (Specify):
Delivery Method:
Seminar/Workshop
Healing Circle and/or Traditional Healing
Cultural Camp
Elder and/or Traditional Teaching(s)
Other (Specify):
Survey
How will you measure
the success of the
Participant Feedback
project?
Evaluation
Other (Specify):
Who is going to deliver the project?
How many individuals do you expect will participate in this project and/or specify the number of First Nation communities it will serve.
How and with whom will results of the project be shared?
List all the partners (funding and/or collaboration) who will be involved in the delivery of this project, such as federal, provincial, municipal,
community, agencies/organizations, police, charities, volunteers, etc.
Partner
Involvement
Declaration
The information provided is accurate to the best of my knowledge.
Given Name
Family Name
Title
Date
(YYYYMMDD)
Page of 2