Application – Baker Lake Education and Recreation Fund

    Please note that you must contribute 10% of the total eligible cost of the purchase

    1. APPLICANT INFORMATION

    First Name
    Last Name
    NTI Number:
    Date of Birth: (MM/DD/YYYY)
    PO Box #:
    Community:
    Postal Code:
    House # and street address:
    Email Address:
    Home Phone:
    Cell Phone:

    APPLICANT ELIGIBILITY

    Program/Project details

    Please describe the education program, event, or workshop and its benefits to the applicant.

    Please attach the following documents before submitting the application. These documents will contribute to the success of your application process.

    Attach a copy of your NTI card(PDF Copies Preferred)


    Attach a letter of support from: Individuals, Group, Organization, Association, or Society(PDF Copies Preferred)


    Cost

    State the total costs of tools, equipment and supplies below. Written quotes confirming prices from suppliers must be attached bellow. Total Costs must include 5% GST Tax and freight charges to your community.

    Equipment, Tools:

    Materials:

    Tuition:

    Other:

    Total Costs:

    Please note the individual or group applying for the grant must contribute 10% of the total purchase cost.

    Applicants Equity:

    KIA grant:

    ED&T grant:

    Other:

    Total Funds:

    Attach copies of quotes from suppliers confirming prices for all material, tools, and equipment(PDF Copies Preferred)




    Any other assistance


    Please list any other assistance secured

    Name of Source:
    Contact Name:

    Dollar Value:

    Name of Source:
    Contact Name:

    Dollar Value:

    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.

    By clicking on the submit button below, I declare that I am applying for funding assistance under the Baker Lake Education and Recreation Fund 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 KIPF or the Kivalliq Inuit Association (KivIA).

    I promise that any assistance received under this program will be used for Education or Recreation.

    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.