"Community Tourism Infrastructure Contribution Program Expressions of Interest Application" - Northwest Territories, Canada

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Community Tourism Infrastructure Contribution Program
Expressions of Interest Application
SECTION A - COVER
Submit to your regional Industry, Tourism and Investment office
Select Region:
Clear Form
North Slave
Organization Name:
Description of organization:
Project Title:
Contact Name/Project Coordinator:
Mailing Address:
Telephone:
Fax:
Email:
Brief Project Description:
How much funding do you need to run
How much are you requesting from the
your project?
Community Tourism Infrastructure Fund?*
$ _____________________
$ _____________________
Checklist. For your expression of interest application to be complete, please provide:
Section A (Cover)
q
Section B (Proposal)
q
Section C (Budget)
q
Letter of support from community government office
q
I acknowledge that the information contained in this application is being collected in accordance with the GNWT’s obligations under the
Access to Information and Protection of Privacy Act. I understand that should my application for funds be approved, the information
contained in this application will be disclosed in an Annual Report produced by the Department of Industry, Tourism and Investment.
The Annual Report will include the names of approved businesses, including trade names; the total amount of financial assistance
provided; the name of the communities in which businesses are located; and/or the locations of the head offices. I further acknowledge
that the Department of Industry, Tourism and Investment may publish aggregate job creation, income, expenditure and other benefits
statistics, based in part on information in this application.
I declare that all of the information provided in this application is true and correct to the best of my knowledge, and I hereby consent to
the reasonable use and disclosure of this information by the Government of the Northwest Territories and its agents for the purposed
outlined above.
DATE:
Name (Printed):
Signature:
Page 1 of 4
Community Tourism Infrastructure Contribution Program
Expressions of Interest Application
SECTION A - COVER
Submit to your regional Industry, Tourism and Investment office
Select Region:
Clear Form
North Slave
Organization Name:
Description of organization:
Project Title:
Contact Name/Project Coordinator:
Mailing Address:
Telephone:
Fax:
Email:
Brief Project Description:
How much funding do you need to run
How much are you requesting from the
your project?
Community Tourism Infrastructure Fund?*
$ _____________________
$ _____________________
Checklist. For your expression of interest application to be complete, please provide:
Section A (Cover)
q
Section B (Proposal)
q
Section C (Budget)
q
Letter of support from community government office
q
I acknowledge that the information contained in this application is being collected in accordance with the GNWT’s obligations under the
Access to Information and Protection of Privacy Act. I understand that should my application for funds be approved, the information
contained in this application will be disclosed in an Annual Report produced by the Department of Industry, Tourism and Investment.
The Annual Report will include the names of approved businesses, including trade names; the total amount of financial assistance
provided; the name of the communities in which businesses are located; and/or the locations of the head offices. I further acknowledge
that the Department of Industry, Tourism and Investment may publish aggregate job creation, income, expenditure and other benefits
statistics, based in part on information in this application.
I declare that all of the information provided in this application is true and correct to the best of my knowledge, and I hereby consent to
the reasonable use and disclosure of this information by the Government of the Northwest Territories and its agents for the purposed
outlined above.
DATE:
Name (Printed):
Signature:
Page 1 of 4
Clear Form
Community Tourism Infrastructure Contribution Program
SECTION B – PROPOSAL
Project Title: _________________________________________________________
1. Please provide an overall summary description of the project.
2. How does the project align with the community tourism plan? If there is no
community tourism plan, is there support from the community? (Please attach
support letter from community government).
3. How does the project provide positive tourism benefits to the community and
surrounding area?
4. How will this project encourage people to visit and stay longer in the community or
surrounding area?
5. How will this project create partnerships between the community government,
non-government community groups and/or the local tourism private sector?
Page 2 of 4
Clear Form
6. How does the project benefit community residents and contribute to the local
economy?
7. What milestones in your project must be reached in order for the project to be a
success? Please provide timelines.
8. Describe how the project maintenance and operation costs will be funded after the
project has been constructed?
9. Evaluation: How will the success of the project be determined? What are the
measurable objectives and how will you report on the progress of your project?
10. Project Start-Date:__________________ End-Date:___________________
11. Groups/Organizations involved (list supporting partners and their roles):
Who?
Role in Project:
Page 3 of 4
Clear Form
Community Tourism Infrastructure Contribution Program
SECTION C - BUDGET
Other
BUDGET
CTIC Program
Explanation: describe all costs,
Funding
(use extra paper/forms if needed)
where applicable.
Funding
Sources
please specify the kinds of
Project Title(s):
materials you are buying or will be
Comments:
Material and Supply Costs
producing as part of your project
$
$
$
$
A. Subtotal Material and Supply Costs:
please specify the
$
$
programming & contracting costs for
Comments:
Contracting Costs
your project.
$
$
$
$
Programming costs
$
$
$
$
B. Subtotal Programming and Contracting
$
$
please specify the
consulting/planning costs for your
Comments:
Consulting/Planning Costs
project.
$
$
$
$
C. Subtotal Consulting/Planning Costs
$
$
please specify any other
costs for your project.
Comments:
Other
$
$
D. Subtotal Other Costs
$
$
E. TOTAL Funding Needed
$
$
A+B+C+D=E
Submit
Clear Form
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