FUNDING APPLICATION

Please check the type of funding you are applying for:

Capital Retrofits Transformation Repairs & Maintenance Capacity Building

Section 1 – Applicant information
Name of Agency	Located in a School YES / NO
Name of School	Name of School Board
Location Address	Ward
Date of application	Application submitted by
Contact Information	Email	Telephone
Project details
Project status	Proposed In progress	Complete
Brief description of the project Describe the stages of implementation of the project, including specific activities and timelines Project estimate or cost $__________________________________ Agency’s financial contribution to the project $__________________________________ Fundraising Dollars $__________________________________ In Kind Support $__________________________________ Other financial support (please specify) $__________________________________ Funding Allocation requested from TBDSSAB BEFORE taxes $__________________________________ Please check which applies □HST □13% □8% □5% Partial advance of funding requested $__________________________________
Reconfiguration requested (if applicable)
Current	Proposed
Infants:	Infants:
Toddlers:	Toddlers:
Preschool:	Preschool:
School age:	School age:
Total:	Total:
Required supporting document – CHECK ALL THAT ARE INCLUDED WITH APPLICATION AND ATTACH A COPY

□ Written report / documentation from licensing, Fire, Health or Children’s Services are included with this application indicating the need for the project.

□ Written estimates from a contractor/supplier are included with this application where the project status is proposed or in progress

□ Invoices are included with this application where the project has been completed within 12 months of application

□ Letter of request and a copy of agency’s most recent monthly financial statement is included where agency is requesting a partial advance payment.

Note: This application does not guarantee funding allocation for projects proposed, in progress or complete. Any financial or contractual agreement the agency undertakes is at their own risk and the TBDSSAB takes no responsibility for any financial investments the agency makes prior to entering an agreement

Section 2 – eligibility criteria
All applications will be assessed and considered based on the criteria and objectives outlined below. Please check “Yes” or “No” to indicate compliance with the items listed below Project falls within estimated budget of $5000 to $50,000 □ Yes □ No Project goals are achievable within a 12 month period □ Yes □ No Agency has an accumulated surplus in the most current audit □ Yes □ No Agency has a lease for this location which is current for 12 months or more □ Yes □ No Agency meeting Quality Assurance Operating Criteria Standards □ Yes □ No Agency has held a clear license for previous 12 month period □ Yes □ No Agency has completed and submitted required documentation for TBDSSAB funded projects in previous years □ Yes □ No Please check the objectives below that apply to this request and provide a brief description of how the project meets objectives: □ Project is required to ensure the program can meet the requirements of the Day Nurseries Act, Quality Assurance Operating Criteria, Public Health or Fire regulations. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ □ Project addresses emerging health and safety needs, including improvement to physical environments. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ □ Investment will be utilized to maintain current child care capacity or service levels. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ □ Investment responds to current service system pressures including accessibility, efficiencies and maintaining age or geographic equity. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ □ Investment is consistent with the transition to the Full Day Learning and supports service for younger children (0-4 years). ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
Signature	Date