Collaborative Grant Application Applicant Information Name of Applicant (Event Coordinator) *Please enter your name Current address *Please enter your address City *Please enter your city Province Please select...AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon*Please select a province Postal Code (A1A 1A1) *Please type your postal code in the following format: A1A 1A1. Phone (123-456-7890) *Please type your phone number in the following format: 123-456-7890 Alternate Phone (123-456-7890) Please use the following format: 123-456-7890 Fax (123-456-7890) Please use the following format: 123-456-7890 Email *Please enter your email address Alternate Email Please enter a valid email address Organization Information Name of Organization *Please enter your organization name Current address *Please enter your organization's address City *Please enter your organization's city Province Please select...AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon*Please select a province Postal Code (A1A 1A1) *Please enter your organization's postal code Has the organization received a NSCMLT grant in the last 3 years? Yes No*Please tell us if your organization has received a NSCMLT grant in the last 3 years If so provide details Invalid Input Management Sponsor Name of Approving Management Representative *Please enter the name of the approving management representative Current address *Please enter an address City *Please enter a city Province Please select...AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon*Please select a province Postal Code (A1A 1A1) *Please enter a postal code Phone (123-456-7890) *Please use the following format: 123-456-7890 Alternate Phone (123-456-7890) Please use the following format: 123-456-7890 Fax (123-456-7890) Please use the following format: 123-456-7890 Email Please enter a valid email address Alternate Email Please enter a valid email address Professional Development Event Information Event Title *Please enter an event title Event Location *Please enter an event location Presenter *Please enter a presenter Event Date *Please enter an event date Additional Event Information Briefly describe the event or program, including details about the instructional methods that will be used. Please provide a description of your event Who from your organization will participate in this event and what is the potential impact on professional development for your participants and for your organization? Please complete this field What are the specific objectives of the event? Please enter the event objectives Will you partner with any other organizations or outside agencies for funding this Event? YesNoPlease answer this question If yes, please indicate the organization and the nature of the partnership. Invalid Input How many participants can your event accommodate? Please enter the number of participants How will you invite other NSCMLT members to your event? Please tell us how you will invite others to your event Event Budget Expenses shall be supported with receipts when the event occurs. Revenue Vendor Donations Invalid Input Registration from members Invalid Input Requested NSCMLT Grant Invalid Input Total Invalid Input ExpensesReceipts Speaker / course fee costs Invalid Input Invalid Input Room rental Invalid Input Invalid Input AV rental Invalid Input Invalid Input Nutrition costs (i.e. lunch break) Invalid Input Invalid Input Other Costs (List details and amounts) Invalid Input Invalid Input Total Invalid Input I have reviewed the information above and understand that if a PD grant is awarded, reimbursement will only be paid to cover eligible documented, itemized expenses that can be supported with receipts, not to exceed the approved award amount. DEADLINE FOR APPLICATION IS May1You must agree to this statement My Management Sponsor has reviewed the information above and acknowledges the described event will proceed if awarded a PD grant.Invalid Input Date Invalid Input
