i am applying as an idea presenter idea presenter: an...

IDEA FAIR AND LEARNING CIRCLE (June 18-20, 2019) IDEA PRESENTER APPLICATION FORM

DEADLINE: November 8, 2018

Version: June, 2018 For assistance contact: [email protected] of 9

I am applying as an IDEA PRESENTER:

Idea Presenter: An individual who will present an idea or potential project at the event. If you prefer to apply as an Idea Supporter, please use the application form for Idea Supporters.

1. CONTACT INFORMATION

Full Name:

Email Address:

Phone Number:

2. ELIGIBILITY (250 WORD MAXIMUM)

Please provide a statement explaining your eligibility: Please indicate if you self-identify as Indigenous (i.e., First Nation, Inuit or Métis) or provide a description of the significant relevant experience that you hold, which makes you an appropriate idea presenter on the topic of Indigenous gender and wellness.

mailto:[email protected]




3. STATEMENT OF INTEREST (500 WORD MAXIMUM)

Please use this space to tell us a little bit about why you are interested in the topic of Indigenous gender and wellness and why you are interested in attending the Idea Fair and Learning Circle.





4. DESCRIPTION OF IDEA/PROJECT (MAXIMUM 750 WORDS)

Please provide a description of the idea or project that you would like to share at the Idea Fair and Learning Circle. The idea should be focused on Indigenous gender and wellness. If you feel it’s necessary, please provide definitions for terms or concepts that may not be widely understood.





5. IMPACT ON THE COMMUNITY (MAXIMUM 500 WORDS)

Please tell us how your participation in this event could benefit your community. Please tell us how you define ‘community’ in this context (what is your community?).





6. BUDGET AND JUSTIFICATIONPlease complete all of the yellow boxes in the budget estimate sections below and provide a total estimate at the bottom of the table, where indicated.

To aid you in estimating your travel and accommodation plans and costs, please note the following details regarding the event timing:

June 18: Half-day, beginning at noon

June 19: Full-day

June 20: Full-day

TRANSPORTATION In the following section, please provide estimates of your transportation costs to Montreal. These estimates should be based on current flight/train/bus costs and include all applicable taxes and fees.

What city and province will you be travelling from (and back to) to attend the event in Montréal?

City:________________

Prov/Terr:____________ Estimated Costs

Primary Transportation: Air, Train, Bus Instructions:

Put an X next to your primary mode of transportation.

If you are travelling by car, skip this section and move tothe next section, below.

Under ‘Estimated Costs’ enter the estimated travel costsfor a round-trip, economy class ticket from your city oforigin to Montréal and back.

Air: ___ Train: ___ Bus: ___

$_____________

Primary Transportation: Car If you are travelling to Montréal by car, you can claim mileage costs. Government of Canada rates differ by province/territory. See note #1, below, for rates and instructions on calculating kilometric rates.

Prov/Terr:___________ Kilometres: ___________

Prov/Terr: ___________ Kilometres: ___________

$_____________

Ground Transportation Instructions: Estimate costs associated with taxis to and from the airport, train station or bus station on either end of your journey (or mid-way if you require a stop over). For the Montréal side, we recommend the following estimates: Airport to meeting venue = $50 each way Bus station to venue = $20 each way Train station to venue = $20 each way

(Please list)

From:____________

To:______________ $_____________

Total transportation costs Instructions: Please add up the amounts in the three boxes above and input the total here.

[Box 1]

$______________





ACCOMMODATIONS In the following section, please provide estimates of your accommodation expenses in Montréal (and mid-way if you require a stop over)

Accommodation Details Estimated Costs

Hotel

Instructions:

• If you plan to stay at a hotel in Montréal, completethis section. If you plan to stay with a friend or familymember in ‘private accommodations’, skip this sectionand move to the next section.

• For Montréal hotels, we recommend budgeting $350 pernight (taxes included) as we have not yet confirmed themeeting venue and costs will depend on what is nearby.

Number of hotel nights in Montréal: _____

Number of hotel nights outside Montréal: ____

$____________

Private Accommodation Instructions: You can claim $50 per day when you stay in private accommodations instead of a hotel.

Number of nights in private accommodation: ____

$____________

Total accommodation costs Instructions: Please add up the amounts in the two boxes above and input the total here.

[Box 2]

$_____________

MEALS You can claim costs for meals during transit and for meals not provided during the event. The amounts are based on the Government of Canada Travel Directive.

Meal Details Estimated Costs

Meal allowances Instructions:

The following meals will be provided at the event andthus cannot be claimed as expenses in this section:June 18: LunchJune 19: Breakfast, Lunch, DinnerJune 20: Breakfast, Lunch

Please indicate the number of meals you will need andprovide the total cost estimate, based on Government ofCanada rates (please see Note #2 for current rates.)

[Box 3]

$____________

Number of breakfasts: ____ Number of lunches: ____ Number of dinners: ____





STIPEND If you will not receive a salary/paycheque from your employer (or if you are required to take personal/vacation days) while attending the event, you can claim a daily stipend for each work day you will miss.

Details Estimated Costs

Stipend allowance Instructions:

Indicate the number of work days you will miss toattend the event.

Multiply the number of work days missed by $200 andenter that number into the cost estimate box.

Number of work days missed:_______

[Box 4]

$____________

TOTAL BUDGET ESTIMATE Instructions: Please add up the totals from boxes 1, 2, 3 and 4 and input the total here. Total budget estimates should not exceed $5,000. If your estimate exceeds $5,000, please complete the justification section, below.

$_____________

Budget Justification (250 word maximum)





If I fail to attend the event, I agree to return the full value of the award to CIHR.

Signature: __________________________________ Date Signed: __________________

8. ADDITIONAL INFORMATION

I will require translation from English to French during the Idea Fair and Learning Circle.

If you have encouraged anyone to apply as an Idea Supporter, please provide their full name(s) here:

9. SUBMISSION INSTRUCTIONS

For your application to be considered complete, you must submit the following documents:

Your completed Travel Award Application Form (this document) as a PDF document.

A letter of recommendation (as a PDF document).

Proof that you will be 18 or older as of April 1, 2019. Acceptable documents include: birth certificate, currentpassport or other government-issued identification that indicates your birth date (e.g., Certificate of IndianStatus). Please submit copy as a PDF document.

Please send all the above documents by email to: [email protected]

Deadline: Complete applications must be submitted by November 8, 2018.

7. ACKNOWLEDGEMENT

First Nations, Inuit and Métis communities are diverse and event participants may be of various gender identities and sexual orientations. With this in mind, I commit to treating all participants with respect.

I agree to share the information contained in this application with CIHR staff.

I agree to attend and participate in the entire Idea Fair and Learning Circle event in Montreal, from Tuesday, June 18 through Thursday, June 20, 2019.






NOTES:

Note #1: Calculating kilometric rates

Government of Canada rates can be found here:

https://www.njc-cnm.gc.ca/directive/d10/v238/s658/en

To obtain your estimated costs for driving, multiply the number of kilometres you will drive by the

kilometric rates in the link above.

Example: Driving from Ottawa to Montreal and back:Ottawa to Quebec border = 121km (Ontario km rate = 58 cents/km)Quebec border to Montreal = 78km (Quebec km rate = 53 cents/km)Ontario: 121 x $0.58 = $70.18 x2 (return trip) = $140.36Quebec: 78 x $0.53 = $41.34 x2 (return trip) = $82.68Total = $223.04

Note #2: Government of Canada Allowance Rates

Canadian $ (taxes included)

Provinces Yukon N.W.T. Nunavut

Meal allowances

Breakfast 19.45 19.65 24.45 26.20

Lunch 19.20 21.20 27.65 33.75

Dinner 48.15 58.50 60.30 89.65


https://www.njc-cnm.gc.ca/directive/d10/v238/s658/en

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