{"id":41604,"date":"2019-05-17T14:56:03","date_gmt":"2019-05-17T14:56:03","guid":{"rendered":"https:\/\/www.cira.ca\/sample-application-form\/"},"modified":"2023-08-09T13:26:48","modified_gmt":"2023-08-09T17:26:48","slug":"sample-application-form","status":"publish","type":"page","link":"https:\/\/stg-saas.cira.ca\/en\/sample-application-form\/","title":{"rendered":"Sample application form"},"content":{"rendered":"<p>This is a copy of the form you will see in our online application system. If you wish, you can use this as a reference to prepare your submission offline, cutting and pasting your answers into the online form when you are ready.<\/p>\n<p><!-- \/block --><\/p>\n<ul>\n<li><a href=\"#section1\">SECTION 1: Organization profile<\/a><\/li>\n<li><a href=\"#section2\">SECTION 2: Project summary<\/a><\/li>\n<li><a href=\"#section3\">SECTION 3: Alignment<\/a><\/li>\n<li><a href=\"#section4\">SECTION 4: Beneficiaries<\/a><\/li>\n<li><a href=\"#section5\">SECTION 5: Project plan<\/a><\/li>\n<li><a href=\"#section6\">SECTION 6: Budget<\/a><\/li>\n<li><a href=\"#section7\">SECTION 7: Community Support<\/a><\/li>\n<li><a href=\"#section8\">SECTION 8: Outcomes and Sustainability<\/a><\/li>\n<li><a href=\"#section9\">SECTION 9: Recognition<\/a><\/li>\n<li><a href=\"#section10\">SECTION 10: Grant opportunity awareness<\/a><\/li>\n<\/ul>\n<hr \/>\n<p><strong>Please refer to the <a href=\"https:\/\/stg-saas.cira.ca\/en\/grants\/how-apply\/\" data-entity-substitution=\"canonical\" data-entity-type=\"node\" data-entity-uuid=\"c06ea0d0-ca57-4923-bc73-8a9eb6a1b200\">Application Guidelines<\/a> when filling out this application.<\/strong><\/p>\n<p>We encourage you to be concise and use plain language. To assist you, we have set word limits for each section. The proposal and budget request should be accurate, brief and clear, keeping in mind that members of the Community Investment Evaluation Panel will have varying degrees of familiarity with the work of your organization. Grants are available up to $100,000.<\/p>\n<hr \/>\n<h2 id=\"section1\">SECTION 1: Organization profile<\/h2>\n<p>Name of Organization \/ Institution<\/p>\n<p><em>This is the organization that will receive the funds and be responsible for the project. If you are applying from a university or college, please include the name of your department.<\/em><\/p>\n<p>Organization Type:<\/p>\n<ul>\n<li>Not-for-profit organization (not registered as a charity)<\/li>\n<li>Registered charity<\/li>\n<li>University or college<\/li>\n<li class=\"MsoBodyText\">First Nations, M\u00e9tis and Inuit communities<\/li>\n<\/ul>\n<p><em>Your organization must fit into one of these categories. If you have further questions regarding eligibility, please contact <a href=\"mailto:grants@cira.ca\">grants@cira.ca<\/a>.<\/em><\/p>\n<p>Incorporation or charitable registration number:<\/p>\n<p>Year of incorporation or registration:<\/p>\n<p>Mailing Address:<\/p>\n<ul>\n<li>Address<\/li>\n<li>City<\/li>\n<li>Province<\/li>\n<li>Postal Code<\/li>\n<\/ul>\n<p>Website Address:<\/p>\n<p>Contact Person Name for this grant<\/p>\n<p><em>This is the lead person who will be most familiar with the project and who is best positioned to answer questions about the project. This is the person who will receive various communications related to the application and selection results.<\/em><\/p>\n<ul>\n<li>Title<\/li>\n<li>Relationship to the Organization<\/li>\n<li>Email<\/li>\n<li>Telephone<\/li>\n<\/ul>\n<p>About Your Organization<\/p>\n<p>Briefly describe your organization including such information as your mission, mandate and purpose. <em>Limit 100 words.<\/em><\/p>\n<p>Organization\u2019s Annual Operating Budget (not necessary for Universities and Colleges) $<\/p>\n<p>Fiscal Year End:<\/p>\n<p>Have you applied for a CIRA Grant before?<\/p>\n<p>yes<br \/>\nno<\/p>\n<p>Have you received a CIRA Grant before?<\/p>\n<p>yes<br \/>\nno<\/p>\n<p>(If yes) How much did you receive?<\/p>\n<p>(If yes) Have you submitted your final report yet?<\/p>\n<p>yes<br \/>\nno<\/p>\n<p><em>Applicants who click no will not be permitted to continue.<\/em><\/p>\n<hr \/>\n<h2 id=\"section2\">SECTION 2: Project summary<\/h2>\n<p>Project title:<\/p>\n<p>Which funding area best describes your internet project?<\/p>\n<ul>\n<li>Infrastructure<\/li>\n<li>Online Safety<\/li>\n<li>Policy Engagement<\/li>\n<\/ul>\n<p>Project Summary\u00a0<em>(limit 200 words)<\/em><\/p>\n<p>Briefly describe the problem or opportunity your project intends to address, what you will do, who will benefit, and the expected results.<\/p>\n<p>One-Line Description <em>(limit 40 words)<\/em><\/p>\n<p>Please summarize the gist of your project in one sentence.<\/p>\n<p>Open Source<\/p>\n<p>CIRA requires that outputs produced through projects funded by the Community Investment Program\u00a0be open and available for anyone to use, share and build upon. Please indicate if you are able to meet this requirement if your project is selected for funding. (limit 100 words)<\/p>\n<ul>\n<li>Yes \/ No<\/li>\n<li>Please explain your answer. (If yes, how; if no, please explain why)<\/li>\n<\/ul>\n<p>Start date<\/p>\n<p><em><em><em>When you anticipate beginning your project. This date should not precede the grant approval date, expected during July 2023.<\/em><\/em><\/em><\/p>\n<p>End date<\/p>\n<p><em><em><em>When you anticipate your project to be completed. A final report on the project will be due three months from this date.<\/em><\/em><\/em><\/p>\n<hr \/>\n<h2 id=\"section3\">SECTION 3: Alignment<\/h2>\n<p>How well does your project align with the overall aim of CIRA&#8217;s Net Good program? <em>Limit 100\u00a0words.<\/em><\/p>\n<p><em>CIRA&#8217;s Net Good grants fund innovative community internet projects to build a resilient, trusted and secure internet for all Canadians.<\/em><\/p>\n<p>In your response, please show how your project aligns with this aim, giving specific reference to the funding area you are applying for:<\/p>\n<ul>\n<li>Infrastructure: CIRA aims to increase the number of Canadians who have access to a high-quality and high-performing internet.<\/li>\n<li>Online Safety: CIRA is focused on increasing Canadians\u2019 cybersecurity knowledge and safety from threats. We want more Canadians to know how to protect themselves and feel safe online.<\/li>\n<li>Policy Engagement: CIRA engages, supports and strengthens a vibrant and influential Canadian internet community. We seek a legislative and policy environment that favours a trusted internet for Canadians.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<hr \/>\n<h2 id=\"section4\">SECTION 4: Beneficiaries<\/h2>\n<p>Describe who will benefit from your initiative and how they will benefit. Please explain your implementation relationship with the beneficiaries and how the project was conceived. <em>Limit 100 words.<\/em><\/p>\n<p>Preference is given to initiatives that benefit:<\/p>\n<ul>\n<li>Northern, rural and Indigenous communities<\/li>\n<li>Students (K-12 and post-secondary)<\/li>\n<\/ul>\n<p>Please identify the number of beneficiaries you intend to reach in any of these target groups relevant to your project:<\/p>\n<p>Students in kindergarten to grade 12:<\/p>\n<p>Post-secondary students:<\/p>\n<p>People in Northern communities:<\/p>\n<p>People in rural communities:<\/p>\n<p>People in Indigenous communities:<\/p>\n<p>People in urban communities:<\/p>\n<p>Please explain how you arrived at these numbers (limit 100 words):<\/p>\n<p>Please identify any other target groups you are aiming to reach and the number of intended beneficiaries in each.\u00a0<em>Limit 100 words.<\/em><\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<h2 id=\"section5\">SECTION 5: Project plan<\/h2>\n<p>Please outline specific key activities for the initiative. Include events or milestones, along with the outputs you will produce during the grant period. Be realistic as you will be required to report on all key activities. Include estimated start and end dates for each. In reading this section, the Panel should get a clear picture of how you will get the work done. You should not exceed 5-7 key activities. <em>Limit 250 words.<\/em><\/p>\n<p>Example Activity:<br \/>\n1. Needs Assessment: Start 07\/15\/2022\u00a0\u2013 End 09\/15\/2022<\/p>\n<ul>\n<li>Form a needs assessment committee<\/li>\n<li>Establish enrollment requirements or prerequisites for potential participants<\/li>\n<li>Determine and set the priorities for 5 workshops<\/li>\n<li>Develop course curriculum and create orientation pamphlet<\/li>\n<li>Prepare a management plan for coordinators, volunteers and participants<\/li>\n<\/ul>\n<p>Output: Training implementation plan<\/p>\n<p>Qualifications<\/p>\n<p>Please describe your organization\u2019s unique qualifications to deliver this project, including reference to:<\/p>\n<ul>\n<li>Project management personnel, skills and\/or resources you will draw on internally or externally<\/li>\n<li>Projects of a similar scale to this request that your organization has managed in the past<\/li>\n<\/ul>\n<p><em>Limit 100 words<\/em><\/p>\n<p>&nbsp;<\/p>\n<div class=\"question\">Please describe your organization\u2019s unique qualifications to deliver this project, including reference to:<\/div>\n<div class=\"description\">\n<ul>\n<li>Project management personnel, skills and\/or resources you will draw on internally or externally<\/li>\n<li>Projects of a similar scale to this request that your organization has managed in the past<\/li>\n<\/ul>\n<p><em>Limit 100 words<\/em><\/p>\n<p>&nbsp;<\/p>\n<div class=\"question\">Environmental Sustainability<\/div>\n<div><\/div>\n<div class=\"description\">\n<p>How does this project take environmental sustainability into consideration?<\/p>\n<p><em>Limit 100 words.<\/em><\/p>\n<\/div>\n<\/div>\n<hr \/>\n<h2 id=\"section6\">SECTION 6: Budget<\/h2>\n<p>CIRA welcomes projects where financial contributions are sourced from multiple sources, including in-kind contributions by the project applicant.<\/p>\n<p>Amount Requested<\/p>\n<ul>\n<li>Should be the same amount as the amount shown as a source of revenue from CIRA on the budget sheet.<\/li>\n<\/ul>\n<p>Total Initiative Budget<\/p>\n<ul>\n<li class=\"MsoBodyText\">The total cost of the project. Should be the same as the total expenses on the budget sheet.<\/li>\n<li class=\"MsoBodyText\">Please identify the specific costs (line items) for which you are requesting funding from CIRA.<\/li>\n<\/ul>\n<p>If the Amount Requested differs from the Total Initiative Budget, please identify the source(s) of additional funding and current status (confirmed or pending). For any pending amounts, please indicate the likelihood of being realized. <em>Limit 100 words.<\/em><\/p>\n<p>Detailed budget<\/p>\n<p>Please complete the Excel budget template attachment found in the online application system. List all revenue sources for the initiative (including co-funding from other sources and in-kind contributions) as well as all expenses. Total expenses must equal total revenue.<\/p>\n<p>Provide budget notes within the budget sheet to help explain the costs, for example: program coordinator salary ($5,000 = 200 hours over 20 weeks X $25\/hr.). Include in-kind support costs. These should be reasonable and in line with acceptable costs in this sector. Get quotes for any items or services to be purchased, and while you do not have to provide these when you submit your application, we may ask for them at a later date.<\/p>\n<p>Also, the financial request should be proportionate to the size and capacity of your organization. You can download the Excel budget template <a href=\"https:\/\/cipapplication.cira.ca\/protected\/r\/FkmBTc_C-GJ6iD28zx8OmIMGf_l09wgH9WHTZXd_ivCCaJPrFNKRNAudfpe9s0a8Nihc7DGD9_vrlTrkMKeRHQ==\/CIRA_Budget_Template_2023.xlsx\">here<\/a>.<\/p>\n<hr \/>\n<h2>SECTION 7: Community Support<\/h2>\n<p>Please describe how your project engages with and involves the local community \u2013 from conception to execution. This can include reference to surveys, consultations, committees, partnerships, financial contributions \u2013 any forms of participation. Please also characterize the key community participants.<\/p>\n<p><em>Limit 200 words.<\/em><\/p>\n<hr \/>\n<h2 id=\"section8\">SECTION 8: Outcomes and Sustainability<\/h2>\n<p>Through its grants, CIRA is seeking outcomes in the following areas. Please indicate the results you expect to achieve in the areas relevant to your project.<\/p>\n<p><em>Enter numbers only, no commas or other special characters.<\/em><\/p>\n<p>Infrastructure:<\/p>\n<ul>\n<li>Number of communities reached:<\/li>\n<li>Number of people reached:<\/li>\n<li>Number of research reports produced:<\/li>\n<\/ul>\n<p>Online Safety:<\/p>\n<ul>\n<li>Number of research reports produced:<\/li>\n<li>Number of educational frameworks produced:<\/li>\n<li>Number of training programs developed:<\/li>\n<li>Number of people trained:<\/li>\n<li>Number of people protected:<\/li>\n<\/ul>\n<p>Policy Engagement:<\/p>\n<ul>\n<li>Number of events or conferences convened:<\/li>\n<li>Number of people in attendance at events or conferences:<\/li>\n<li>Number of research reports produced:<\/li>\n<\/ul>\n<p class=\"MsoBodyText\">Other Measures<\/p>\n<p>Please describe any other quantitative or qualitative measures you are planning to track. <em>L<\/em><em>imit 100 words.<\/em><\/p>\n<p class=\"MsoBodyText\">Specific Results<\/p>\n<p>Please describe the specific changes you expect to result from your initiative \u2013 whether at the individual, group, organizational, community or institutional level. (limit 100 words):<\/p>\n<p>Please describe the longer-term impact you expect from this project. (limit 100 words):<\/p>\n<p>Sustainability<\/p>\n<p>Please describe how you will sustain what you achieve through this project, after the grant is finished. <em>Limit 100 words.<\/em><\/p>\n<p>For research institution applications: How will your project advance your field of work and the Internet in Canada? <em>Limit 100 words.<\/em><\/p>\n<hr \/>\n<h2 id=\"section9\">SECTION 9: Recognition<\/h2>\n<p>Selected grant recipients are required to acknowledge funding from CIRA.<\/p>\n<p>If this grant application is approved for funding, how will you recognize CIRA&#8217;s support? <em>Limit 100 words.<\/em><\/p>\n<p><em>Simple forms include the use of our logo on your website and in any published materials about your project, mentions in media relations, social media and events.<\/em> <em>Further guidance on this will be provided in your agreement.<\/em><\/p>\n<hr \/>\n<h2 id=\"section10\">SECTION 10: Grant opportunity awareness<\/h2>\n<p>How did you hear about CIRA\u2019s Community Investment Program Grants: (select all that apply)<\/p>\n<p>A colleague or friend<br \/>\nAnother applicant<br \/>\nCIRA staff member or CIRA board\u00a0member<br \/>\nMember email from CIRA<br \/>\nEmail from third party \u2212 third party: ______________________<br \/>\nMedia article \u2212 name of publication: ______________________<br \/>\nSocial media (Facebook, Twitter, LinkedIn, etc.) _____________<br \/>\nInternet research \u2212 search term ______________________<br \/>\nOther, please describe ______________________<\/p>\n<hr \/>\n<h2 id=\"application\">This application was authorized by:<\/h2>\n<p>Name<\/p>\n<p>Title (i.e. Executive Director\/ President\/Chair, Board of Directors)<\/p>\n<p>Signature<\/p>\n<p>Signature will be taken electronically.<\/p>\n<p>By checking the following boxes, I declare the following:<\/p>\n<p>I am authorized to approve this application for funding and its associated budget.<\/p>\n<p>I have reviewed the contents of the application and provided my approval.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This is a copy of the form you will see in our online application system. If you wish, you can use this as a reference to prepare your submission offline, cutting and pasting your answers into the online form when you are ready. SECTION 1: Organization profile SECTION 2: Project summary SECTION 3: Alignment SECTION [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"content-type":"","inline_featured_image":false,"ngg_post_thumbnail":0,"slim_seo":{"title":"Sample application form - CIRA","description":"This is a copy of the form you will see in our online application system. If you wish, you can use this as a reference to prepare your submission offline, cutti"}},"category":[668],"class_list":["post-41604","page","type-page","status-publish","hentry","cira_category-state-of-the-internet"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-06-12 23:49:02","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"translation_priority","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/pages\/41604","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/comments?post=41604"}],"version-history":[{"count":4,"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/pages\/41604\/revisions"}],"predecessor-version":[{"id":115030,"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/pages\/41604\/revisions\/115030"}],"wp:attachment":[{"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/wp\/v2\/media?parent=41604"}],"wp:term":[{"taxonomy":"cira_category","embeddable":true,"href":"https:\/\/stg-saas.cira.ca\/en\/wp-json\/cira\/v1\/category?post=41604"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}