Report on Activities and Expenditures

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Form Instructions

DCI# 4548549 (2014-2015)

Privacy Act Statement

This statement explains the purposes of collecting your personal information and how it is used. Only information needed to respond to program requirements will be requested. Collection and use of personal information is in accordance with the Privacy Act. In some cases, information may be disclosed without your consent pursuant to subsection 8(2) of the Privacy Act.

Contact your regional office or program contact for information on the authority under which your personal information is collected and used.

We will use your personal information as assurance that the information contained in the form is accurate or to contact you about information contained in the form. We do not share the personal information you give us. The information collected is described in the Program Administration Class of Personal Information detailed at Info Source. Contact your regional office or program contact for information on the retention and disposition of your personal information.

As stated in the Privacy Act, you have the right to access your personal information and request changes to incorrect information. Contact your regional office or program
contact to notify us about incorrect information.


Recipient Name
Recipient Number


Choose the program on which you are reporting from the list below. Selecting a program hides the fields that are not required for that program.

  • Aboriginal Financial Officers Association of Canada
  • Assessment and Historical Research: Special Claims
  • Assisted Living
  • British Columbia Capacity Initiative
  • Comprehensive Claims Submission
  • Consultation and Policy Development
  • ecoENERGY for Aboriginal and Northern Communities Program
  • Emergency Management Assistance Program
  • Enrolment and Ratification
  • Family Violence Prevention Program: Prevention Projects
  • Federal Initiative on Consultation
  • First Nations Child and Family Services
  • Gathering Strength: Reorientation to Self-Government
  • Gathering Strength: Reorientation to Self-Government -
    Capacity Development
  • Group Independent Assessment Process
  • Income Assistance
  • Income Assistance: Enhanced Service Delivery Projects
  • Income Assistance: Reform Pilot Projects
  • Income Assistance: Shelter Allowance Pilot Projects
  • Inherent Right
  • Inherent Right: Consultation
  • Intergovernmental Forums: Interim Métis Organizational
  • Intergovernmental Forums: Regional Intergovernmental
  • Intergovernmental Forums: Territorial Development
  • Mackenzie Valley Land and Water Board
  • Negotiation Preparedness Initiative
  • Negotiation Preparedness Initiative: Capacity Development
  • Office of the Treaty Commissioner
  • Pre-implementation Funding for Self-Government Agreements
  • Professional and Institutional Development
  • Specific and Special Claims Negotiations
  • Specific and Special Claims Submission
  • Treaty Commission and Discussions
  • Yukon Environmental and Socio-Economic Assessment Act


Project Name
Project Number


There are two options available to complete this form: you may enter the information directly on the form, or you may complete the Recipient Identification and Program Identification sections and attach a document containing the information required for the program you have selected.

Additionally, any deliverables specified in the recipient's funding agreement should be attached if completed.

Name of document

Method of Submission


Date From (YYYY-MM-DD)
Date To (YYYY-MM-DD)


  • Provide a brief description of the activity.
  • If the activity was completed within the period identified above, enter the date the activity was completed.
  • If the activity was not completed within the period identified above, explain why it was not completed and describe any work completed within this period.
  • List any deliverables associated with this activity that are specified in the recipient's funding agreement and attach if completed.
  • Provide any additional comments you would like to share regarding this activity.
  • If this is a final report, describe the final outcomes and any highlights.


ecoENERGY for Aboriginal and Northern Communities Program

If this is a final report, describe the current stage of the project based on the work activities completed, the project next steps, and the anticipated construction/operation date of the project.

Identify any aspects of the project that have changed that may affect the estimated greenhouse gas emissions reductions of the project


Date From (YYYY-MM-DD)
Date To (YYYY-MM-DD)

Budget Item
Budget Amount
Expenditure Amount

In-Kind Sources (if applicable)
Source Name
Value (Optional)
Total In-Kind Sources


The information provided is accurate to the best of my knowledge

Given Name
Family Name


Enter the contact information for the individual(s) responsible for completing this form.

Given Name
Family Name
Telephone Number
Extension Number
Fax Number
Mailing Address (Number/Street/Apartment/P.O. Box)
Province or Territory
Postal Code

If you require an alternate format, please email us at: