Disabilities Initiative Report

PDF Version - Fill & Print (143 Kb, 2 Pages)

Form Instructions

DCI# 471949.GCIMS (2015-2016)

Privacy Act Statement

This statement explains the purposes for the collection and use of 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. The collection and use of personal information for this Assisted Living Sub-Program within Social Development is derived from the Department of Indian Affairs and Northern Development Act, R.S.C., 1985, c. I-6, as well as from annual Appropriation Acts granting authority to the Government to spend funds on programs. 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 AANDC PPU 215 detailed at Info Source. The information collected will be retained for a period of five years, then sent to Library and Archives Canada. 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.

Section A: Contact Information

Recipient Name

Recipient Number

Region

Reporting Period From (YYYYMMDD)

Reporting Period To (YYYYMMDD)

Contact – Given Name

Family Name

Title

Mailing Address (Number/Street/Apartment/P.O. Box)

City/Town

Province/Territory

Postal Code

Telephone Number

Facsimile Number

Email Address

Section B: Financial Summary

Total funding from AANDC's Disabilities Initiative

Project expenditures:
Provide the project expenditures, broken down by activity and/or objective.

  • Navigator Service
  • Information Services
  • Public Education and Awareness
  • Community Outreach
  • Information Sharing Events
  • Other (Specify):

Total AANDC Funds Spent

Section C: Project Context

Project Summary (no more than 200 words)

Project Results and Outcomes (no more than 200 words)

List all the partners (funding and/or collaboration) who were involved in the delivery of this project, such as federal, provincial, municipal, community, agencies/organizations, charities, etc.

Partner
Involvement

How many individuals were actually reached?

Population Group(s):

Select the group(s) reached and indicate the total (estimated) percentage of individuals who participated in the project by population group.

Women
Men
Children
Youth
Elders
Caregivers
Professionals (e.g. Counselors, Doctors, Academics, etc.)
Persons With Disabilities
Other (Specify)

Attachment(s):
Indicate the name(s) of supporting document(s) being submitted and the method of submission.

Name of Supporting Document
Method of Submission

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

Given Name

Family Name

Title

Date (YYYYMMDD)