"Go Nb Person With a Disability Development Grant Application Form" - New Brunswick, Canada

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Download "Go Nb Person With a Disability Development Grant Application Form" - New Brunswick, Canada

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Person with a disability
Development Grant
SECTION 1. Lead Applicant Information
Organization name:
Name of contact person for this request:
Name of president or chair of organization:
Mailing Address:
Telephone number:
Contact Email:
About your organization
Type of organization?
Provincial Sport Organization
Multisport Organization
Other non-profit organization, please specify:
SECTION 2. Information about the project or activity
Name of project/activity:
Are you seeking multi-year funding (maximum 2)? Yes
No
Is this a program for:
Integrated – Open to all
Targeted only for persons with a disability
The implementation of any physical literacy aligned program
Improvement to an existing program
The purchase of specific adaptive sport equipment for para sport participants
Project Details
Start date:
End date:
How many times per week?
Duration:
Location(s) of project:
___________________
Person with a disability Development Grant - Page 1 of 5
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Person with a disability
Development Grant
SECTION 1. Lead Applicant Information
Organization name:
Name of contact person for this request:
Name of president or chair of organization:
Mailing Address:
Telephone number:
Contact Email:
About your organization
Type of organization?
Provincial Sport Organization
Multisport Organization
Other non-profit organization, please specify:
SECTION 2. Information about the project or activity
Name of project/activity:
Are you seeking multi-year funding (maximum 2)? Yes
No
Is this a program for:
Integrated – Open to all
Targeted only for persons with a disability
The implementation of any physical literacy aligned program
Improvement to an existing program
The purchase of specific adaptive sport equipment for para sport participants
Project Details
Start date:
End date:
How many times per week?
Duration:
Location(s) of project:
___________________
Person with a disability Development Grant - Page 1 of 5
Please indicate what LTAD program you will be using. For reference:
http://canadiansportforlife.ca/resources
/ltad-sport-models)?
How will you recruit participants?
How will you recruit coaches/leaders?
Provide program details and if a multi-year application, what is planned for the following year.
Please explain how will you ensure sustainability/ continuation of participation once your project/activity is
completed (e.g. referral to other internal or external programs)?
How will you promote this project and publicly acknowledge Sport Canada, the Government of New Brunswick
and others as source of funding for this project? Please explain.
Person with a disability Development Grant - Page 2 of 5
Please indicate what stage of athletes are involved in your project?
Awareness
First Involvement
Active Start
FUNdamentals
Learn to Train
Train to Train
Please indicate the approximate number of participants, leaders/coaches, officials, and administrators involved
in your project.
Male
Female
Total
Participants / athletes with a disability
0
Participants / athletes without a disability
0
Leaders / coaches
0
Officials
0
Volunteers
0
TOTAL
0
0
0
SECTION 3. Training
Do you currently have one coach trained to work with participants with a disability? Yes
No
Please specify
What training/certification do your coaches/leaders currently have? (i.e. Fundamental Movement Skills,
Coaching Athletes with a disability Module, Training provided by Special Olympics, Aboriginal Coaching
Module, NCCP training, Physical Education Teacher, or other). Please list.
Do the coaches, officials, and leaders of your organization require additional training?
Yes (complete next question)
No (skip to section 4)
Please contact
http://www.coachnb.com/
or your national sport organization for information on coaching
courses.
Please specify date, the region, and the approximate cost for the additional training:
Date
Number of
Location (region)
Cost
Type of training
(mm/dd/yy)
participants
*Please keep in mind, a minimum of one coach must be trained to work with participants with a disability
Person with a disability Development Grant - Page 3 of 5
SECTION 4. Partnerships
What partners have you identified to support the project? (i.e. people to help out, school, district, municipality,
etc.) Please list your partners and their role for the delivery of your project/activity/event.
Partner
Contact person
Role/qualifications
SECTION 5. COVID-19
Has your organization developed a COVID -19 operational plan that addresses public health and safety
measures as per GNB current phase of recovery? Yes
No
Has your organization developed a COVID -19 operational plan that addresses public health and safety
measures as per GNB current phase of recovery? Yes
No
Does your national sport organisation have a Return to Play strategy developed?
Yes
No
If YES, did you use this guidance in the elaboration of your COVID – 19 operational plan? Yes
No
Does your organization have special expenses related to the COVID - 19 situation? Yes
No
How much additional costs?
Brief explanation of those costs?
SECTION 6. Adaptive sport equipment for para sport participants
Please describe the equipment you wish to purchase and how it will be used to increase participation in sport
by para-participants/para-athletes
.
Person with a disability Development Grant - Page 4 of 5
SECTION 7. Maintenance, Storage and Transportation Plan
As a requirement of the application, please provide detailed maintenance and storage plan for any adaptive
sport equipment purchased with this funding. Attach appendix if additional space required.
SECTION 8. Budget Information
Project Budget (all years – attach separate multi-year budget if necessary)
Notes
a) Have you / or will you secure other funding for this project, please include.
b) Applicant requesting adaptive equipment must submit a minimum of 1 formal quote.
Estimated Revenues
Amount
Estimated Expenses
Amount
Items
Items
TOTAL
TOTAL
$ 0.00
$ 0.00
Total Amount Requested:
$ 0.00
SECTION 9. Completion of Application
Accountability Declaration of Partners
I, the undersigned, am authorized by my organization to forward this application. The information presented in
this application is, to the best of our knowledge, true and correct.
Furthermore, in the event that our application is successful, we agree to:
1. Receive and account for all project funds, through the Lead Organization.
2. Participate in evaluation / monitoring activities related to the project.
3. Provide proof of insurance coverage for the program.
4. Ensure project is implemented and that all obligations for reporting are met.
5. Ensure that a final activity report is submitted 30 days after the project is completed.
Signature of Applicant:
Date:
Please submit completed applications by email at sr/sl@gnb.ca; fax to 506-453-6548 or mail to:
Marysville Place, P. O. Box 6000, Fredericton, NB, E3B 5H1
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