"Parennial Crop Development Program Application Form" - Prince Edward Island, Canada

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Download "Parennial Crop Development Program Application Form" - Prince Edward Island, Canada

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APPLICATION FORM
Perennial Crop Development Program
Project/Client # (Office Use Only):
1.
Applicant Information
Full Name (including middle name):
Organization Name:
Mailing Address:
Organization’s Twitter Handle (if
applicable)
Village/Town/City
Province
Postal Code
Telephone No.
Cellular No.
Fax No.
E-mail Address
Preferred method of communication:
 Telephone
 Cellular phone
 SMS Text Message
 Email
 Other (please specify)
1.1
Type of Business or Organization.
Choose one and complete the required information:
 Individual Proprietorship (if you file to Canada Revenue Agency as an individual)
Social Insurance Number: ____________________________________
 Incorporated Company (if you file to Canada Revenue Agency as a corporation)
(This number can be found on your tax forms and is required under the authority of the Income Tax Act)
Revenue Canada Business Number: ____________________________
 Partnership (if you file to Canada Revenue Agency as a partnership.)
Please include Revenue Canada Business Number
Revenue Canada Business Number: ____________________________
 Registered Charitable Organization / Not-for-Profit
Please include the charity registration number
Registration number: ___________________________________
 Other
Please Identify: ___________________________________
Registration number: ___________________________________
November 2019
APPLICATION FORM
Perennial Crop Development Program
Project/Client # (Office Use Only):
1.
Applicant Information
Full Name (including middle name):
Organization Name:
Mailing Address:
Organization’s Twitter Handle (if
applicable)
Village/Town/City
Province
Postal Code
Telephone No.
Cellular No.
Fax No.
E-mail Address
Preferred method of communication:
 Telephone
 Cellular phone
 SMS Text Message
 Email
 Other (please specify)
1.1
Type of Business or Organization.
Choose one and complete the required information:
 Individual Proprietorship (if you file to Canada Revenue Agency as an individual)
Social Insurance Number: ____________________________________
 Incorporated Company (if you file to Canada Revenue Agency as a corporation)
(This number can be found on your tax forms and is required under the authority of the Income Tax Act)
Revenue Canada Business Number: ____________________________
 Partnership (if you file to Canada Revenue Agency as a partnership.)
Please include Revenue Canada Business Number
Revenue Canada Business Number: ____________________________
 Registered Charitable Organization / Not-for-Profit
Please include the charity registration number
Registration number: ___________________________________
 Other
Please Identify: ___________________________________
Registration number: ___________________________________
November 2019
1.2
Partnerships.
If you indicated “Partnership” as your type of business in Section 1.1, please list the partner name(s) and their
ownership per cent in the table below.
Name of all partners (for partnerships)
Per cent of ownership
Total (must total 100%)
2.
Project Information
Project Title: _____________________________________________________________________
Project Start Date: ____________ Project End Date: ____________ Total Weeks: _____________
Funding Amount Being Requested: ________________________
2.1
Project Funding
Have you, or will you, secure any other Provincial and/or Federal Government funding for this project?
 Yes
 No
If yes, provide detailed information as indicated below
Source
Dollar Amount
2.2
You are applying as:
(please choose only one)
Primary producer
Producer Organization
Processor
Processor Organization
Other industry organization (i.e., associations,
Research body (i.e., university, hospital, and
agri-service provider)
research institute, information institute, etc.)
Retailer/Wholesaler/Input supplier
Provincial/Territorial Government
Indigenous government/Indigenous
Municipal Government
community/Indigenous group
November 2019
2.3
Type of Industry
(Please choose only one)
 Oilseed and grain farming
 Vegetable and melon
 Fruit and tree nut farming
 Greenhouse, nursery and
(1111)
farming (1112)
(1113)
floriculture production (1114)
 Other crop farming (1119)
 Beef Cattle Ranching and
 Hog and pig farming (1122)
 Poultry and egg production
Please specify:
Farming, including feedlots
(1123)
______________________
(11211)
 Sheep and goat farming
 Support activities for animal
 Dairy Cattle and Milk
 Other animal production
(1124)
production (1152)
Production (11212)
(1129) Please specify:
______________________
 Support activities for crop
 Dairy product manufacturing
 Fruit and vegetable
 Animal food manufacturing
production (1151)
(3115)
preserving and specialty food
(3111)
(3114)
 Grain and oilseed milling
 Other food manufacturing
 Meat product manufacturing
 Seafood product preparation
(3112)
(3119)
(3116)
and packaging (3117)
 Bakeries and tortilla
 Farm product merchant
 Beverage manufacturing
Fiber, yarn, and thread mills
manufacturing (3118)
wholesalers (411)
(3121)
(3121)
 Agricultural, construction
 Professional, scientific and
 Food, beverage and tobacco
 Food and beverage stores
and mining machinery
technical services (541)
merchant wholesalers (413)
(445)
manufacturing (3331)
 Forest nurseries and
 Multiple Industries
Not applicable
gathering of forest products
Please specify:
(1132)
______________________
2.4
Project Activity Area
(Please choose only one)
 International Market Development
 Domestic Market Development
 Business Development
 Climate Change Mitigation and Adaptation
 Research
 Training, Knowledge Transfer and Awareness Raising
 Adopting a New Technology, Activities/Practices, Process or Product
 Assurance Activities
 System, Equipment and Facility Modernization
 Pre-Commercial Development, Prototyping, and Demonstration
 Commercialization
 Miscellaneous (please specify)
2.5
Project Proposal (2-3 pages)
Please use the topics listed below as the subject headings of your proposal.
Cover Page
Include the project title, expected start and end date of the project, and your contact information.
Executive
Provide a summary of the farm, farm operators, and the conditions leading to this project.
Summary
November 2019
Project Objectives
Describe the issue your project is designed to address and the project’s final objectives.
Description of
Describe in detail any existing perennial crop enterprises and of any other farming enterprises that are
farm enterprise
managed by you.
Description of
Please refer to the PEI Department of Agriculture and Land factsheet “Site Assessment, Selection and
proposed
Development for Perennial Crops”
perennial crop
Describe the orchard/vineyard/perennial crop planting site, and indicate its suitability for perennial crop
site and
production which includes the following information: a history of the site and what crops were grown
development
previously, a list of soil improvements, a current description of soil texture, nutrients and drainage. Please
conducted to date
also describe the aspect and slope of the site and its exact location.
Site Ownership /
Please describe the ownership / leasing structure of the site, and attach proof of ownership / leasing
Leasing
documentation.
Planting Plan
Please include a five-year planting plan that includes: description of the varieties of perennial crops
(rootstock and scions), trellis support systems (if necessary), sources of perennial plants, and a short
description of how the fruit will be sold (e.g., retail/wholesale).
Market Plan
Describe the annual value or revenue of the new plantings and support systems and to what extent this
value or revenue will contribute to the growth or sustainability of the farm operation (once they are
established). Describe what specific areas this value is coming from (e.g. increased volume, increased
price, increased quality, access to new markets, development of a new value-added product or other
items).
Timeline
Identify the project’s timeline and activities (including submission of the project’s final report). Include the
activity’s description, any person(s) or organizations associated with the activity and the activity’s start and
end date.
Results
State the expected commercial and/or economic benefits to your farm. Also, please note if there are
positive environmental impacts expected because of this project.
CAP Outcome
The Perennial Crop Development Program will contribute to the CAP outcome of increasing the
environmental sustainability of the sector. Please describe how your project will positively contribute to this
specific outcome.
Climate Change /
Please describe any implications your project may have with respect to climate change adaption or
Carbon
mitigation and/or carbon sequestration.
Sequestration
Budget
Identify total project costs and funding requested from the program.
Evaluation
How will you measure whether the project investments and activities achieved the objective of this project?
How will you measure progress made toward achieving the project objective? How will you communicate
the evaluation results?
Communication of
Please describe how you intend to recognize the support of the Department in communication material
Support (if
related to the project.
applicable)
3.
Public Trust
The Department may increase support to projects in receipt of CAP funding in order to enable the implementation of
communication activities that aim to reinforce confidence and public trust in the agriculture sector on PEI.
Do you wish to be considered for this funding?
 Yes
 No
4.
Department Goals
Please choose one goal to which your project most aligns.
 Environmental Stewardship
Promote environmental stewardship
 Local Food
November 2019
Support local food through initiatives that promote a better understanding of where food comes from.
 Food Sales, Security and Safety
Develop a food cluster that promotes food sales, security and safety.
 Innovation, Sales and Exports
Encourage innovation, sales, and export possibilities for agriculture, fisheries and aquaculture.
 Public Trust
Enhance the public’s trust in PEI’s agri-food and seafood sectors.
 Human Capital
Development of a human capital strategy for PEI’s primary industries and food manufacturing.
5.
Declarations and Consent to Use Personal Information
By submitting this form for project funding, I/We:
understand that personal information on this form is collected under Section 31c of the Freedom of Information and
Protection of Privacy Act R.S.P.E.I. 1988 c. F-15.01 as it relates directly to and is necessary for the Canadian Agricultural
Partnership program being delivered as part of the Canada-Prince Edward Island Canadian Agricultural Partnership
Framework and Bilateral Agreement. It will be used for determining eligible for program assistance and will be shared
with the Canada Revenue agency regarding the taxable benefit and Agriculture and Agri-Food Canada, regarding
program management, claims, audits, and evaluation of this program;
agree that information provided for purposes of the Canadian Agricultural Partnership may be shared with the Canada
Revenue Agency as it pertains to any potential taxable benefits, as well as with Agriculture and Agri-Food Canada or its
agent regarding claims, audits and evaluations as it relates directly to and is necessary for this contract being delivered
as part of the Canada-Prince Edward Island Canadian Agricultural Partnership Framework and Bilateral Agreements;
agree to participate in an evaluation and/or audit of the program;
understand that projects funded may be communicated through the Department’s public and social media channels;
understand that failing to comply with all application requirements may delay the processing of the application, or may
render me ineligible for receiving assistance under the program;
understand that the Social Insurance Number, Business Number and/or Charity Registration Number is collected under
the authority of the Income Tax Act for the purposes of reporting income;
acknowledge that my/our completing this application form and by receiving advice from the Department or other program
delivery agent does not oblige the Department or other delivery agents to provide funding;
understand that expenses incurred prior to the submission of an approved application are not eligible for assistance
under this program; and
agree that a completed Final Report including financial verification will be provided to the Department via email
(perennialcrop@gov.pe.ca) within 60 days of the completion of the project.
I, certify that the information given on this application is to the best of my knowledge complete, true and accurate.
Name of Applicant/Signing Officer
Signature of Applicant/Signing Officer
Date
(Please print)
6.
Demographic Information.
Your voluntary response to the following questions will assist the Department in understanding the
demographic profile of CAP clients.
Do you identify as
 Man
 Woman
 Gender not listed
 Prefer not to say
Are you a senior (age 65 or older)?
 Yes
 No
 Prefer not to say
Are you a youth (age 29 or under)?
 Yes
 No
 Prefer not to say
Do you identify as a person with a disability?
 Yes
 No
 Prefer not to say
What is your first language?
 English
 French
 Other
 Prefer not to say
November 2019
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