"Application Form - Future Farmer Program" - Prince Edward Island, Canada

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Download "Application Form - Future Farmer Program" - Prince Edward Island, Canada

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APPLICATION FORM
Future Farmer 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: ___________________________________
June 2019
APPLICATION FORM
Future Farmer 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: ___________________________________
June 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.
Applicant Information
Residency
Are you a resident of PEI?
Yes
No
Citizenship
Are you a Canadian citizen?
Yes
No
If no, are you a permanent resident?
Yes
No
Education
Do you have a high school diploma or a GED?
Yes
No
What is your highest level of post-secondary education?
PhD
Masters Degree
Undergraduate Degree
College Diploma
Not applicable
If you have indicated that you have post-secondary education, please summarize your education below:
June 2019
Please list any other training experience or certificates held
Farm History and Experience
Are you currently filing farming income on your tax return?
Yes
No
If yes, what was the first year you claimed farming income on your tax return? ______________________
Are you planning to join an established farming operation?
Yes
No
If yes, how is the farm structured?
Sole Proprietorship
Partnership
Corporation
Cooperative
Do you currently own farming acreage?
Yes
No
If yes, how many acres do you currently own? ______________________
Briefly describe the type of farming operation that you currently own/plan to develop?
The Future Farmer Program requires that you generate $20,000 in annual gross farm sales by the end of the third year in the
program. Please provide budgetary details regarding how you expect to generate the farming income.
Has an Environmental Farm Plan been completed for your farm during the past five years?
Yes
No
Not applicable
June 2019
2.1
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
2.2
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)
______________________
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
June 2019
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
(futurefarmer@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
Are you proficient in languages other than English or
 Yes
 No
 Prefer not to say
French?
Do you identify as a member of the Island’s Acadian
 Yes
 No
 Prefer not to say
community?
Do you identify as a member of an Indigenous group?  Yes
 No
 Prefer not to say
Do you identify as a newcomer to Canada?
 Yes
 No
 Prefer not to say
Do you identify as part of another under-represented
 Yes
 No
 Prefer not to say
group?
June 2019
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