ARCHIVED - Urban Aboriginal Strategy / Cultural Connexion for Aboriginal Youth Recipient Activity Repot - Form Instructions

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Note:  The reporting template is expected to be available in February 2014 for publishing in the Reporting Guide. The template has not changed significantly and note that "CFA" will be replaced by the word "Agreement.

If there are any questions regarding completion of the form, please contact the Program Development Officer assigned to your Agreement.

General Information

Recipient Name
Agreement Number
Project Name

Report Schedule

Reporting Period (YYYYMMDD)
The period of time stated here must correspond with the report periods outlined in the contribution agreement.

Due Date
Identify who completed the report (report must be signed by the recipient who signed the Agreement or the individual to whom the responsibility has been delegated by the recipient.)

Activity Report Completed By:
Given Name
Family Name
Telephone Number
Email Address
Financial Report Completed By:
Given Name
Family Name
Telephone Number
Email Address

Report Options:

If you want to write your report on the form instead of attaching a separate document, please ensure the "On this form" buttons are clicked under the heading "Report Options".

Is the Project Complete?
Yes or No

Identify where the report has been recorded and submitted.

Interim Activity
On this form or Attached as a document.

Interim Financial
On this form or Attached as a document.

Refer to the Urban Aboriginal Strategy Recipient Project Reporting Guide for instructions and examples of how to complete the Interim Activity and Financial Reports.

Interim Activity Report
If you already have a report that your organization has produced which contains the information required below, you do not need to fill out this section – simply attach the report.

Please comment on the degree to which this project is meeting its objectives and indicators. What has the project accomplished/completed to date?
Refer to Agreement Work Plan – Summary Description and Performance Indicators (Benefits) section.

Are you on track with your project activities and milestones listed within your Agreement Work Plan? What has the project accomplished/completed to date?
Refer to Agreement Work Plan – Activity and Milestones Timelines section.

Has anything impacted your ability to move towards your indicators, activities and milestones within your Agreement Work Plan?

Do you have any stories that you would be interested in highlighting and sharing from this project?

For Cultural Connections for Aboriginal Youth (CCAY) Projects

Please indicate the number of total youth participants who have access the CCAY project in the appropriate category and age range.

Age Category 10-14 Years 15-24 Years 25-29 Years*

*If the ages of the participants are between the ages of 25-29, justification must be provided to the Program

**Section available for those individuals who identify as Two Spirited, or Transgender

Please provide any additional comments that your organization would like to share in relation to the project (ie. Unexpected outcomes or anticipated outcomes).

Interim Financial Report

Ensure that your breakdown of revenues and expenditures match what is listed in your agreement (refer to Agreement Work Plan – Project Costs section), reflecting the total project revenues and expenditures and not just the UAS amount. The recipient must sign the financial statement once completing the actual total of revenues and expenditures to date.

To complete the required financial report, please fill in the amounts for this reporting period in the correct headings below.

Revenues Budget Amount (As per Agreement) Total Actuals for the Entire Agreement Total UAS Actuals Total CCAY Actuals
AANDC – UAS        
AANDC – CCAY        
Expenditures Total Cost for Project Contributions from Other Partners AANDC – UAS Contribution AANDC – CCAY Contribution
Salary and Benefits        
Professional Fees        
Equipment (Rental/Lease/Purchase)        
Communication Products        
Other Direct Costs Related to the Project        

Recipient Signature – Submitted by

Given Name
Family Name
Signature of Applicant

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