Multiculturalism Grant Program Application Form Office of Immigration & Multiculturalism Name of Applicant/Organization:(Required) Title of Project:(Required) Start Date:(Required) Day Month Year End Date: Day Month Year Mailing Address: Street Address Address Line 2 City Province / Territory Postal Code Contact Person:(Required) Title: Phone Number:Email: Please provide a description of your event including (but, not limited to): Goals, Activities, and Anticipated Outcomes:(Required)Total Event Costs:(Required) Financing Requested:(Required) Have you applied for, or do you anticipate, other government financial assistance for this project?: No Yes If yes, please provide details, including current status of assistance: Department / Agency Amount Requested Pending / ConfirmedPendingConfirmationName of Authorized Official:(Required) Signature of Authorized Official:(Required)To sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.Date:(Required) Day Month Year Incorporation Number: Date of Incorporation: Day Month Year Privacy statement(Required) I agree to the privacy statement.Until OIM has issued a Notice of Competition Results, only Departmental evaluators will have access to the application. Applications submitted under NLMGP will become property of the Government of Newfoundland and Labrador; consequently, they will be subject to the terms of the Access to Information and Protection of Privacy Act (ATIPPA). The applicant’s responsibilities under ATIPPA will be detailed further in their Contribution Agreement. Applicants should note that any proprietary, personal, or sensitive information contained in their proposal should be marked as confidential and will be subject to appropriate consideration as defined within ATIPPA. Public requests for information under ATIPPA will not ordinarily include any materials deemed to be proprietary in nature. Contact Information Office of Immigration and Multiculturalism Department of Jobs, Growth and Rural Development Tel: 709-729-7733 E-mail: diversity@gov.nl.ca
