Application – Kivalliq Community Cultural Initiatives Program


    Full Name (As it appears on your ID):
    NTI Number:
    Date of Birth:
    PO Box #:
    Postal Code:
    House # and street address:
    Email Address:
    Home Phone:
    Cell Phone:
    Work Phone:


    Name of Project/Program:
    Click all that apply

    Please write other details here

    Name of Administrator:
    Location of Program:

    Approximate # of Participants:

    Project will include from the following group(s)

    Project Proposal

    Please describe the following in detail: The intent of your project, why you feel this project is important in your community? How do you plan on carrying out your project? What will be necessary to succeed? What are your expected outcomes? What benefits will this project have on people?

    Please write program details here


    Project Budget

    You must provide a detailed budget breakdown of cost by category. Ex.) Rental fees, instructor fees, supplies etc. Maximum $5000, Rental fees do NOT exceed 20% ($1000), Instructor fees do NOT exceed 40% ($2000) and administrative fees do NOT exceed 10% ($500) of the total budget.

    Dollar value:

    Total Budget:
    Total Requested from KIA:
    Please attach quotes that you received that will be part of the program. These quotes will contribute to the success of your application process.

    Attach copies quotes(PDF Copies Preferred)

    Any other assistance

    Please list any other assistance secured for your project

    Name of Source:
    Contact Name:

    Dollar Value:

    Name of Source:
    Contact Name:

    Dollar Value:


    You must enclose at least two letters of support with your application from Non-family members. Please list below the persons who provided these letters. These letters will contribute to the success of your application process.

    Attach copies of reference letters(PDF Copies Preferred)

    Declaration and Submission

    I hereby certify that the information contained in this application is true and correct to the best of my knowledge and ability, and that I do not have any outstanding debts to the Kivalliq Inuit Association.

    I agree to release my ATV, boat, outboard motor, snowmobile, cabin and all other camping and hunting equipment for the purpose of this proposed program.
    I, further agree that KIA is not responsible for damages that may occur before, during and after the completion of this program. Furthermore, KIA is not responsible for any liability before, during or after the completion of the proposed project. All proponents and participants involved are solely responsible on the own accord.

    By clicking on the submit button below, I declare that I am applying for funding assistance under the Kivalliq Community Cultural Initiatives Program (KCCIP) administered by the Kivalliq Inuit Association. I swear that to the best of my knowledge, all of the statements or information in this application are true. I understand that any false or misleading information will result in my application being denied and may disqualify my organization or myself from receiving future funding assistance from KCCIP or the Kivalliq Inuit Association (KivIA).

    I give permission to KIA to collect and use my personal information related to this application to make inquiries needed to evaluate this application. Upon receiving assistance, I will agree to supply any relevant receipts, records or other relevant information requested by the KIA.

    My receipt of assistance will not make me an employee, contractor or agent of KivIA.

    I further believed this declaration to be true and know that it is the same as if made under oath.