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CSA Class Contribution Program

CSA Class Contribution Program to support Awareness

CONTRIBUTIONS APPLICATION FORM

Canadian Space Agency
Space Learning Program
6767 Route de l'Aéroport
Saint-Hubert, Québec
J3Y 8Y9 Canada

Instructions for completing this form:

You must answer all fields as indicated. Your application will not be considered if there is missing or incomplete information.

Submit this application form along with the constitution of the organization.

For any additional information, please contact Jason Clement.

It is the applicant's responsibility to ensure that the application complies with all relevant federal, provincial/territorial and municipal laws.

Section 1 — Information on the Applicant

Applicant Designation:

Name of applicant (organization):

Name of individual submitting the proposal on the applicant's behalf:

Title and/or position of individual within the organization:

Address:

City:

Province :

Postal code: (ex : J3Y8Y9)

Telephone number: (ex : 450-123-4567)

E-mail address :

Confirm E-mail address:

Annual reach of organization:

Annual number of youth reached:

Describe major space-relevant activities, projects or initiatives undertaken by the applying organization:

I understand that I will be contacted to participate in pre-funding, post-funding, and follow-up (if applicable) evaluation surveys, regardless of the outcome of my application for funding.

I certify that any former public office holder or public servant employed by our organization complies with the provisions of the relevant Conflict of Interest and Post-Employment Code for Former Public Office Holders and the Value and Ethics Code for Public Servants respectively.

We have consulted with the linguistic minority to ensure that this initiative meets their needs (applicable for national organizations)

FOR QUEBEC INSTITUTIONS

The applicant is subject to chapter M-30, An Act respecting the Ministère du Conseil Exécutif

Section 2 – Information on the Proposal

1. Executive Summary — Please provide a high-level resume of what the proposed project entails, i.e. a description of the project, its scope, the expected target audience level (from a youth/student perspective) and quantitative reach, whether the initiative will be offered in one or both official languages, and the benefits to Canada or to Canadian youth, and/or students anticipated through the execution of the proposed initiative.

2. Purpose of the Initiative — Please describe the rationale/need for the development of the proposed initiative and indicate any linkages to the objectives of the Space Awareness Contributions Program (outlined below).

Program Objectives:

i. To increase awareness of Canadian space science and technology among Canadian youth and educators and their participation in related activities;
ii. To provide learning opportunities to Canadian students and physicians in various space-related disciplines; and
iii. To support the operations of organizations dedicated to space research and education.

3. Deliverables — indicate what the deliverables of the proposed initiative are (i.e. space-related pedagogical content, extra-curricular hands-on activities, etc.)

4. Implementation Approach — Please provide a description of how the development and delivery of the proposed initiative will be undertaken.

5. Team Members — Please provide the names and relevant qualifications of team members proposed to develop and/or implement the proposed initiative indicating the role of each in the project.

6. Schedule — Please provide a detailed (monthly) schedule for the development and/or implementation of the proposed initiative.

7. Budget — Please provide a detailed and complete budget breakdown for all costs associated with the project and specify areas where funds are being requested of CSA (list of eligible expenses follows)

Eligible costs for contributions will be direct expenses associated with the delivery of approved projects that are required to achieve the results to which they relate. Costs will include one or a combination of the following categories:

salaries and benefits;
consultants services;
material and supplies;
acquisition or rental of equipment;
access fees;
licenses and permits fees;
data acquisition;
data management;
launcher services;
participation fees at conferences, committees and events;
travel;
accommodation and meals allowances;
training;
translation services;
registration fees;
costs related to obtaining security clearance;
acquisition, development and printing of materials;
marketing and printing services;
publication and communication services;
overhead (administrative) costs (not to exceed 20% of eligible costs for universities and 15% for other eligible recipients); and
PST, HST and GST net of any rebate to which the recipient is entitled to and the reimbursement of any taxes for goods and services acquired in a foreign country net of any rebate or reimbursement received in the foreign country.

8. Project financial support:

Outline any current and proposed future funding from other sources.

Source (Name of institution and funding program)

Pending /
Granted? ¹

For pending funds, date for announcement

Attach the notification letter

¹ Attach a copy of the notification letter. This should clearly identify the project name, funding agency and the result(s) of the demand. For awards that are pending, please indicate the expected date for the announcement.

Privacy Notice

Necessary measures have been taken to protect the confidentiality of the personal information you provide. The information you provide is collected under the authority of the CSA Act. This information will be used to determine the eligibility of applicants for funding and may be used to subsequently provide you with information on other available opportunities.

Your personal information will be held in the CSA Personal Information Bank for the appropriate program for 2 years. It is protected under the Privacy Act. According to the Privacy Act, you have rights with respect to the information you submit. You may upon request:

Be given access to your file
Have incorrect information corrected or have a notation attached

For more information about your rights see Info Source. This is a Government of Canada publication available in major libraries, at government information offices and from constituency offices of federal Members of Parliament.

Space Awareness Contributions Program Committee
Request Assessment Form

Requirement	Score	Comments
Organization and Initiative meet eligibility requirements as outlined in the Terms and Conditions approved by Treasury Board		Yes / No
Project, if undertaken, will ultimately provide benefits to Canadians, particularly Canadian students/youth	/ 15
The project's objectives and deliverables are well thought out and can be reasonably achieved within the proposed timeframe and budget	/ 25
Budgetary resources requested respect eligible costs and reflect realistic costs with respect to the proposed initiative	/ 15
The extent to which the proposed event meets Program objectives.	/ 15
The team proposed clearly demonstrates the necessary skills and experience to complete the development and/or delivery of the proposed initiative	/ 15
The expected reach of the initiative demonstrates a sound return on requested investment	/ 15
Total Score	/ 100