ARCHIVED - Urban Partnerships Recipient Activity Report 2015-2016


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PDF Version - Fill & Print (145 Kb, 3 Pages)

Form Instructions

DCI# 41766.GCIMS (2015-2016)

Privacy Act Statement

This statement explains the purposes and use of your personal information. 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.

Authority for the collection and use of your personal information in connection with the Urban Aboriginal Participation Program (also referred to as the Urban Aboriginal Strategy) is derived from the Department of Indian Affairs and Northern Development Act, R.S.C., 1985, c. 1-6, s 4 as well as from annual Appropriation Acts granting authority to the Government to spend funds on the Program. We will use personal information for assessing and determining eligibility for the administration of the program to which you are applying, and for reporting on aggregated results. We share the personal information you give us with those as outlined under Record Number: AANDC RO 900, detailed at Info Source.

The information collected will be retained for a period to be determined, upon appraisal by Library and Archives Canada during an AANDC departmental Records Disposition Authority (RDA) Coverage Project (The RDA Coverage Project is forecasted to be completed within the next two years).

As stated in the Privacy Act, you have the right to access the personal information you give us and request changes to incorrect information.  Contact your regional office to notify us about incorrect information, or contact the AANDC Public Enquiries by phone at 1 (800) 567-9604 for general enquires. For more information on privacy issues and the Privacy Act in general, you can consult the Privacy Commissioner at 1 (800) 282-1376.

General Information

Recipient Legal Name
Funding Agreement Number
Project Name

Report Schedule

Reporting Period (YYYYMMDD)
Due Date

Recipient Contact

Given Name
Family Name
Telephone Number
Email Address

Report Options:

Is the Project Complete?
Yes or No

Identify where the report has been recorded and submitted.

Final Activity Report

Final Financial Report

Final Activity Report

Contact the DIAND representative identified in the "Part 9- Notices" section of the funding agreement for instructions on how to complete the Urban Partnerships Recipient Activity  Report.

If you have  a report that  you have  already produced that contains the information required below,  you do not need to fill out this  section;
simply  attach  the report.

Comment on the degree to which this project met its objectives and each of the activities and milestones. (Refer  to Annex  2 of your Funding Agreement and/or  the DIAND approved Urban Partnerships Work Plan Summary Description and Activities & Milestones Timelines sections)

National Project Indicators Noted in DIAND Approved Work Plan Indicator Noted
in DIAND Approved
Work Plan?
Expected Result Actual Result
Number  of organizations/individuals targeted through leadership development initiatives Yes or No    
Number  of urban community planning processes Yes or No    
Number  of Regional Plans created Yes or No    
Number  of Community Plans created Yes or No    
Number  of partnerships created or sustained with one or more of the four key stakeholders  (Provincial, Federal, Aboriginal, Municipal) Yes or No    
Number  of articulated arrangements  with provincial governments created or maintained Yes or No    
Number  of identified opportunities  to align government Yes or No    

Are there unique performance  indicators for this project?

If "Yes", comment  below:

If the project exceeded  or struggled to meet its targets for the indicators listed above, indicate why.

What is the future sustainability  plan of this project and its partnerships,  now that this agreement  has ended?

Do you have any additional success stories, best practices,  lessons learned and/or any other positive aspect that you would like to highlight or share from this project?

Provide any additional comments that your organization  would like to share in relation to the project (i.e., unexpected outcomes or anticipated outcomes).

Final Financial Report

Ensure that your breakdown of revenues and expenditures matches what is listed in your agreement  (refer to "Part E-1" of your Funding Agreement- Work Plan- Project Costs section), reflecting the total project revenues and expenditures and not just the UAS amount. The recipient must sign this 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 Actual Budget Amount
(per funding agreement)
Other Funders    
Expenditures Actual Budget Amount
(per funding agreement)
Add a Rowl    
Employee Benefits    
Salaries Total    
Professional  Fees    
Travel and Meetings    
Other Direct Costs    
Add a Rowl    
Direct Costs Total    
Add a Rowl    
Administration Total    

Recipient Authorization

The information  provided is accurate to the best of my knowledge.

Given Name
Family Name

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