CSRF – ENGLISH – United Way of Southeastern Alberta

Community services recovery fund

Section 1A: Consent

Consent - Please read the following and indicate consent by clicking 'I Agree' followed with your full name and electronic signature.(Required)

I agree.

Community Services Recovery Fund Application Form

We appreciate your interest in the Community Services Recovery Fund.

Prior to completing this application, we encourage you to visit the Community Services Recovery Fund website. The website includes a brief Where to Apply quiz that will direct you to the correct National Funder.

Please read the Applicant Guide and Annotated Application Form to ensure you understand the CSRF application form questions and process.

• Note that if you are completing this application form, you are applying to the Investing in Program and Service Innovation and Redesign project focus area.

• We suggest you draft your responses and collect all attachments before entering your application on the portal.

• A PDF of the application form is available.

Section 1A: Consent

The information collected by United Way Centraide in this Application will be used for the purposes of: (a) evaluating your application to the Community Services Recovery Fund (the Program); (b) assessing and supporting your general expression of need for funding; (c) providing and continually improving such services; (d) communications, research, and advocacy activities; and (e) communicating with you.

The information you provide may also be disclosed in full or part to the other CSRF National Funders, government agencies, including the Government of Canada, service providers or other third parties as required to validate, confirm, approve and administer your application and funding; for statistical, evaluation, monitoring, and research purposes; coordination to avoid duplication; promote and/or advertise the Program; or as otherwise required by our contract with the Government of Canada, law, or regulation.

You understand and acknowledge that information disclosed to government authorities and other third parties ceases to be under the control of United Way Centraide, and that such information will be handled in accordance with the laws and policies applicable to such third parties and may be used and disclosed by such third parties for their own purposes (which may differ from the purposes described above). You acknowledge that United Way Centraide is not responsible or liable for the acts or omissions of government authorities or other third parties that are not acting as agents or service providers to United Way Centraide.

While United Way Centraide does not collect any personal information as part of this Program, if you do inadvertently disclose personal information in your Application, it will be handled in accordance with United Way Centraide's privacy policy.

Many United Way Centraides use digital platforms to administer the Program. Please note that information transmitted online is never entirely secure and is subject to the security policy of the respective digital platform.

Lastly, the name of your organization, the funding received, and the nature of the activities being funded may be posted on the United Way Centraide Canada and/or local United Way Centraide website. Accordingly, such information will be publicly available.

Please indicate your acceptance of these terms by signing below.

Name

First Last

Signature

Section 1B: M30 (Only required in Quebec)

1. Are you based in the Province of Quebec?(Required)

Yes, our organization is located in the Province of Quebec

No, our organization is located outside the Province of Quebec

2. If yes, is your organization subject to the M30 Act?(Required)

Yes

Disclaimer

Acknowledged.

At the time of writing the following document, a CSRF exemption agreement is in progress but is not yet signed between the Government of Canada and the Government of Quebec. Funding applications for applicant organizations subject to the M30 Act will be evaluated once an agreement is signed. Organizations will be informed when an agreement is reached.

Section 2: Organizational Information

1. How did you hear about the program?(Required)

How did you hear about the program? (other)(Required)

2. Provide the contact details for the primary contact, in case we have questions about your application.(Required)

First Last

Phone(Required)

Email(Required)

3. In which language does your organization prefer to receive communications?(Required)

English

French

4. Legal Name of Organization(Required)

5. Common Name of Organization(Required)

6. Collaboration: If this project is a collaboration, list all organizations involved. (optional)

7. Address of Organization (Include Suite / Unit if applicable)(Required)

Street Address City Province Postal Code

8a. Website of Organization

8b. Social Media of Organization

9. Mission/Mandate of Organization(Required)

10. Organization Type(Required)

11. CRA T3010A URL(Required)

Provide a direct link to your organization’s CRA T3010A. Example: Registered charities or qualified donees have a webpage on the CRA website.

12. Is your organization registered federally or provincially/territorially?(Required)

Federally

Provincially/territorially

None of the above

13. Enter the registration, incorporation, band number, or society number of the organization(Required)

14. Sub-sector: Select one of the options from the International Classification of Non-profits that best describes your organization’s sub-sector(Required)

15. Sustainable Development Goal (SDG) alignment. Select the SDG that best aligns with the mission/mandate of your organization? (choose one)(Required)

16. How many volunteers, including board members, does your organization currently have?(Required)

Please enter a number from 0 to 999999.

17. How many full-time staff does your organization currently have?(Required)

Please enter a number from 0 to 999999.

18. How many part-time staff does your organization currently have?(Required)

Please enter a number from 0 to 999999.

Impact of COVID-19

19. Describe how your organization, staff, and volunteers and/or programs/services have been impacted by the COVID-19 pandemic. (max. 150 words)(Required)

Populations and Locations Served

20a. What PRIMARY population is served by your organization?(Required)

20b. What SECONDARY population is served by your organization?(Required)

20c. What OTHER population is served by your organization? Select all others that apply.(Required)

21. Which provinces or territories are served by your organization? (choose all that apply.)(Required)

22. Which locations does your organization primarily serve? (choose one)(Required)

23. What is the annual revenue of your organization?(Required)

$49,999 and under

$50,000 to $149,999

$150,000 to $499,999

$500,000 to $1,499,999

$1,500,000 to $4,999,999

$5,000,000 or more

Governance

24. Is your organization in good standing with the Canada Revenue Agency, your provincial registry, or the applicable regulatory body?(Required)

Yes

25. Please provide a list of the individuals on your board of directors or management committee, etc. (must be a minimum of 3 people)(Required)

26. Does your organization have practices and procedures in place for internal controls and accountability?(Required)

Yes

27. Does your organization have a bank account in the name of the organization and a financial management system to track the income and expense transactions of the organization effectively?(Required)

Yes

28. Date of Operation. On what date did your organization first begin operating?(Required)

Leadership and Diversity, Equity, and Inclusion

29. “Nothing about us, without us”. Describe how your organization actively brings an equity lens to its work using the principle of ‘nothing about us without us’. This principle recognizes that individuals with lived experience know what is best for themselves and their community and that their participation is integral to the success of the program. When the principle is used, the organization’s work is guided by the needs and aspirations of the people being served. Those people served are provided meaningful opportunities for participation in project planning, leadership, evaluation, and promotion. (min = 50 words, max = 250 words)(Required)

30. Does your organization consider itself to be led by one or more of the following equity-deserving group(s)? The applicant organization may consider itself to be an organization led by one or more equity-deserving group(s) if members of these groups influence the organization's mission, strategic direction, investment decisions, key activities, and project decisions. Typically, this would include influential positions on the board of directors or senior management.(Required)

Project Information

31. Project Title. Share the title of your project. (max. 10 words)(Required)

32. Project Description. Describe your project in two sentences. The first sentence should describe what the project will do. The second sentence should describe how the project will support your organization to modernize and/or adapt. (max. 60 words)(Required)

33. Project Focus. Which of the following is the primary focus of your project?(Required)

34. Project Type(Required)

Project Plan and Desired Results

35. Project Plan. Describe your project’s timeline and activities. Provide as much detail as possible. Example: Month 1 to 2 Conduct technology audit (12 rows)(Required)

Month(s)

Activity

36. Project Deliverables: List deliverables such as new tools, strategies, approaches, and others, that will be developed as a result of the project. (max. 100 words)(Required)

37. Project Results: Describe the expected project results and how they will support your organization to modernize and/or adapt. (max. 100 words)(Required)

38. Mission/Mandate: Describe how this project will help your organization better deliver on its mission/mandate. (max. 100 words)(Required)

39. Project oversight. Who will be the main individuals (by role/function) involved in overseeing the project?(Required)

Name

Role

Project Responsibilities

Project Budget and Financial Information

40. Project Budget. Detail your project’s overall budget in the table provided.

Tier 2 Funding Requests

See the Applicant Guide for specific criteria and details related to Tier 2 funding requests.

43. Are you requesting between $100,001 - $200,000 in the local stream and does your organization meet the specific criteria?(Required)

Yes

44. Describe the progress of your project to date. For Tier 2, projects must be in the implementation and/or stabilization phase, meaning the work has progressed past planning and is already underway. (max. 200 words)(Required)

45. Identify how your project is being carried out. Choose one of the following three:(Required)

46. How will the organizations involved in the project directly benefit from the results? (max. 150 words)(Required)

Financial Information

47. Financial Documents. Upload the following documents as per the description below(Required)

Drop files here or

Max. file size: 50 MB.

1. Required Documents for Registered Charities and Other Qualified Donees: Last annual report, donor report, annual general meeting report, or report to stakeholders on activities (such as a newsletter) & Most recent financial statement 2. Required Documents for Registered Non-Profits and Other Non-Qualified Donees: Governance documents, preferably including your local or federal registration number, such as: Incorporation documentation, if incorporated (i.e., Articles or Letters Patent), Provincial Registry document, Trust Deed, if a trust, Most recent tax filings (2020 or 2021), T2 return or T2 Short Form (if incorporated), Non-profit organization information return (Form T1044), Most recent financial statements, Last annual report, donor report, annual general meeting report or reporting to stakeholders on activities (such as a newsletter) Ensure your statements are complete, meaning that they are: Signed and dated by the accountant and accounting firm or approved by your Board of Directors or management committee. We cannot accept draft statements. Submitted on the accountant’s or accounting firm’s letterhead for all externally prepared statements. Consolidated for organizations with branches, chapters, subsidiary organizations, or any controlled entities.

Terms & Conditions

[content from UWCC to be added]

Certifications & Signature

I have all the necessary authorities, permissions, and approvals to bind my organization and submit this Application. I agree that I have not received other funding from any other third party for the activities outlined in this Application. I shall notify United Way Centraide and withdraw my Application if I receive other funding for these activities. I understand that I can only submit one application to the Community Services Recovery Fund (“Program”) through a United Way Centraide or another National Funder. I understand that additional documentation may be required in support of this Application and that additional documentation can be requested and reviewed to confirm the accuracy of the information provided. I understand that by certifying this Application, I attest that all information is true, accurate and complete and that any false statements or deliberate omissions may disqualify this Application. I have read and understand the Terms & Conditions provided by United Way Centraide at the point of application. I understand that by submitting this Application, I agree to be bound by and to comply with the Terms & Conditions. I understand that there may be other requirements that my organization will be expected to comply with if my Application is approved. I declare that my organization is not insolvent. By signing below, I affirm that I have read, understand, and comply with all certifications listed above.(Required)

I Agree

Signature(Required)

Name(Required)

First Last

2SLGBTQIA+
Black Canadians
Children (0-15)
First generation immigrants, refugees or newcomers
General population
Indigenous Peoples: First Nations
Indigenous Peoples: Inuit
Indigenous Peoples: Métis
Lone parent families
Official language minority communities
Other racialized communities
People experiencing homelessness or housing insecurities
People from Northern Canadian communities
People living on low income
People living with cognitive or mental health related issues
People living with physical, sensory or pain related disabilities
People of advanced age (65+)
People suffering from terminal or chronic illness/diseases
People without a bachelor's degree or an advanced educational qualification
Persons living with disabilities
Survivors of domestic violence, sexual assault, abuse, or stalking
Veterans
Women
Youth (15-24)
None of the above