APPLICATION
KIA Inuit Initiatives Fund
I am applying as the following:
£ Organization
£ Business
£ Individual
# ________ % _______
_____________________
__________________
# of Members & percent of NLCA Beneficiaries
NTI Business #
NLCA Beneficiary #
Name (organization, business or individual):
Mailing Address, Community, Postal Code:
Phone:
Fax:
E-mail:
A. Project Description:
This purpose of this application is to support the following. (Check one or more.)
 Inuit cultural initiatives, including community cultural and traditional events
 Inuit wellness initiatives, including recreations, sports and social events
 Other (specify):__________________________________________________________
1) Please provide a brief description of the initiative for which you are requesting support. If necessary,
please append addition information to this application form.
2) Project Start Date:
Project End Date:
3) Where will the initiative be undertaken and who is the expected audience?
4) i. Please list supporters of your initiative.
ii. Please attach letters of support.
iii. Please name administrator, work title and phone number who will be filling your final report.
Application: KIA Inuit Initiatives Fund 2012
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___________________________________________________________________________
____________________________________________________________________________
B. Estimated Project Costs:
Item
Details (#people, unit cost, etc)
Amount
Travel
$
Other (provide details)
$
Other (provide details)
$
Other (provide details):
$
Other (provide details)
$
Total Project Costs:
$
C. Sources of Funding
Details
Amount
Total Project Costs:
$
Applicant’s Equity
(25% or more)
$
Other Funding Source
$
Other Funding Source
$
Amount Requested from KIA
$
D. Project Benefits
1) How many participants will be assisted by this initiative?
2) How does your initiative contribute to Inuit culture and/or wellness?
3) a. How many people will your project employ?
b. How many Inuit will your project employ?
4) a. How many people will your project train?
Application: KIA Inuit Initiatives Fund 2012
For how long?
For how long?
Type of Training:
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b. How many Inuit will your project train?
Type of Training:
5) Is this a Pan-Regional initiative (please refer to Inuit Initiative Terms of Reference for further detail)?
If yes, please elaborate how all Kitikmeot communities can benefit the initiative.
F. Applicant Signature
I do swear that I have personal knowledge of the information discussed in this application. To the best of
my knowledge, all statements made and materials provided by or on behalf of the undersigned are true
and correct.
Signed this
day of
, 20
, in
.
Signature of Applicant & Date
Witness signature & Date
G. Application Process
Application for the KIA Inuit Initiatives Fund can be made at any time of the year. Applications should
include supporting documentations including plans, quotes, research, letters of commitment, etc. For
more information contact:
•
Your local KIA Community Liaison Officer, or
•
KIA Department of Beneficiary Services in Cambridge Bay @ Ph: (867) 983-2358
Submit completed applications to either your local KIA Community Liaison Officer or:
Department of Beneficiary Services
Kitikmeot Inuit Association
Box 18,
Cambridge Bay, Nunavut, X0B 0C0
Ph: (867) 983-2458 Fax: (867) 983-2701
Application: KIA Inuit Initiatives Fund 2012
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