Community Support for Sexual Misconduct Survivors Grant Program Application Form

Please consult the Application Guide before filling out this form.

You may apply for multiple grants (project-based and recurrent), provided that the proposed projects and related expenses are distinct. These requests must each be submitted using separate application forms.

Questions and completed applications should be sent to: SMSRCGrant-SubventionCSRIS@forces.gc.ca.

Part A – Organization information

Legal name of organization:
Operating name of organization (if different from the legal name):
Telephone number:
Email address:
Website (if applicable):
Social media (if applicable, including LinkedIn, X, Facebook, Instagram, and any others):
Federal riding name and number:
Street address:
Mailing address (if different from street address):
Is your organization's street address confidential?
- Yes
- No
Who is the organization's main contact? Please provide their name, title, and contact information.
Who is the organization's Executive Director (or equivalent) if different from the main contact? Please provide their name, title and contact information:
Which official language would you prefer we use in written and spoken communications with your organization?
- English
- French
How did you find out about this Grant Program?
- Website
- Colleague/word of mouth
- SMSRC communications
- Other communications
- Other (please specify):
Provide a brief description of your organization's mandate.
Provide a brief description of each of your organization's currently offered programs, initiatives and services.

table for wider defence community
Program, initiative or service title (e.g., counselling, peer support, etc.)	Description (max 665 characters)
-	-

Provide a brief description of your organization's primary client group(s)/target population.
What is your organization's geographic reach?
What measures does your organization take to ensure that services and facilities are inclusive and adapted to meet diverse needs? (Please indicate all that apply.)
- Examples may include, but are not limited to:
  - Barrier-free access (e.g., ramps, automatic doors, etc.) (please specify):
  - Communication accessibility (e.g., TTY (text telephone), sign language, interpretation, etc. (please specify):
  - Service animal access
  - Language interpretation
  - childcare, bus or taxi fare):
Does your organization have any recognized accreditations? If so, please provide the name of the accrediting body, date of accreditation, and expiry (if applicable).
Has your organization undergone any relevant changes (such as growth or reduction in personnel, or significant changes in leadership) in the past two (2) years? (max 1,365 characters)

If yes, please describe the changes and the current status. (max 1,365 characters)

Legal eligibility

Is your organization a Canadian not-for-profit organization?
- Yes
- No

If 'Yes', please provide proof of not-for-profit organization status when submitting your application.

If 'No', please consult the application guide for further information on eligibility. You may also contact the SMSRC to obtain clarifications on this matter.

Nine-digit incorporation/registration (GST) number: ___________

Is your organization located in the Province of Québec?
- Yes
- No

If your organization is subject to the Act respecting the Ministère du Conseil exécutif (M-30), please provide a copy of your authorization from the Québec government.

Has your organization applied for or received funding from any other sources, including any level of government (federal/provincial/territorial/municipal) or a private foundation in the last three years?
- Yes
- No

If 'Yes', please provide the funding sources, amounts and start/end dates of the funding, and a point of contact for each funding source. Please also identify if this funding was related to the proposed project (max 1,365 characters).

Do you or your organization owe any amounts to the Government of Canada?
- Yes
- No

If 'Yes', we will follow up with you at a later time to collect further information.

Part B – Project evaluation

table for wider defence community
26. Project title: (max 100 characters) If your organization is awarded a grant under this program, the project title and description will be published on Canada.ca.	-
27. Grant Type (one-time, up to $50,000 for one year or recurrent, up to $75,000 annually for up to three years)	-
28. Duration of project
29. Service Type	Counselling Outreach Education Peer Support Research Crisis Line Other (please specify):
30. Project Language (English, French, and/or other)
31. Geographic Reach (including virtual offerings)	-
32. Identify which of the following groups within the wider Defence community do you intend to reach.	Cadets Currently serving Canadian Armed Forces (CAF) members Current and former Department of National Defence public service employees Junior Canadian Rangers Staff of the Non-Public Funds Veteran/former CAF members Families, loved ones, and caregivers of the above Other (please specify):
33. Identify if any efforts will be made to reach the following groups	Women Men Gender diverse people 2SLGBTQI+ communities Indigenous peoples Black, Asian and other racialized people People living with disabilities (both visible and invisible) Official language minority communities Other diverse populations or communities (please specify)

Please describe the needs the project will address. (max 3,450 characters)
Please describe the project objectives (e.g., the number of individuals you expect to reach, the number of sessions planned, reduction or elimination of wait times for those in the wider Defence community, etc.). (max 3,450 characters)

Project objectives should be clearly described and be specific, measurable, achievable, relevant and time bound to achieve the program outcomes (as detailed under the section 'Part B: Project Evaluation' of the Application Guide).

Describe your project's key activities and associated timelines. If you are requesting a recurrent grant, please provide a breakdown for each year. (max 3,450 characters)
Please describe the project outputs and outcomes, including how your project contributes to the Expected Outcomes of the Grant Program, and any evidence that supports how the Expected Outcomes will be achieved. (See Application Guide for Expected Outcomes.) (max 3,450 characters)
Describe your or your organization's capacity, experience, and expertise to carry out the proposed project and work with those impacted by sexual misconduct. (max 3,450 characters)
Describe how your proposed project addresses the specific needs of diverse groups of women, men, and gender diverse people who have been affected by sexual misconduct in the DND/CAF, as well as how it will improve access or inform enhancements to supports and services. (max 1,365 characters)
Describe how the project will include diverse perspectives in its design and delivery, and how intersectional Gender-Based Analysis Plus (GBA Plus) will be applied to achieve the project's objectives. This includes the use of methods and approaches that are consistent with federal objectives related to GBA Plus. For example, methods and approaches that:
- are sensitive to context, intersecting factors, lived realities, and experiences of inequality help identify and mitigate potential bias and barriers
- support more inclusive impacts
Please explain how your approach to your project, programming and/or service delivery is trauma-informed. (max 3,450 characters)
Please explain how your approach to your project, programming and/or service delivery demonstrates innovation in reaching underserved communities and populations. (max 1,365 characters)
What relationships and/or collaborations do you or your organization currently have that could be relevant to this project (for example, organizations within the wider Defence community, sexual assault centres, local authorities, research institutions, etc.)? If an organization is a collaborator for your proposed project, please identify in 'Relationship Description' the role(s) and expertise they will bring to the project (e.g., implementing partner, advisor, financial and/or in-kind support).

Organization	Relationship Description (max 2,075 characters)	Name of contact person	Title	Email	Telephone

Part C – Budget

Please attach the organization's annual financial statements and annual reports from its two (2) most recent years of operations to this application.

Please provide a detailed financial breakdown by category, including all sources of revenue and all expenditures. Explain precisely how the funding requested will be used, indicating which expenditures the grant will cover, and providing a detailed explanation of how these expenditures were calculated. If you have identified financial contributors in the question above, their contributions should be in your budget table.

The table below is a screenshot for reference only. Please use the Excel template for this section and submit it with your completed application.

detailed financial breakdown by category
Cost Description	Direct Costs	Indirect / Overhead Costs (can not be over 15% of funding)	Total Costs (automatically calculated)
		Costs
A. Staff salaries, wages and benefits
Staff Salary	$	$
Direct Wages (for employees working on hourly rates)	$		$
Benefits	$	$	$
B. Professional fees
	$		$
C. Travel
	$		$
D. Materials and supplies
	$	$	$
E. Facilities
	$	$	$
F. Office equipment
	$	$	$
G. Publicity and promotion
	$	$	$
H. Other (specify)
	$	$	$
Total (automatically calculated):	$	$	$
Total funding requested:		Field and text will highlight read if > 15% of total funding requested

Note: If you are applying for multiple grants, you must submit separate budgets with distinct expenditures. The stacking limit as described in the application guide must be respected.

Please describe the impact of partial funding (i.e., if the SMSRC awards your organization a grant of a lower value than the amount requested).

Part D – Declaration

I, _____________________________ [insert signee's name], the undersigned, on behalf of _____________________________ [insert legal name of organization], applicant to the Community Support for Sexual Misconduct Survivors Grant Program administered by the Sexual Misconduct Support and Resource Centre (SMSRC) on behalf of the Minister of National Defence, hereby certify that I am authorized to submit this application on behalf of _____________________________ [insert organization's name].

Important Information and Signature

Please read the Application Guide and all information below, including the Privacy Notice Statement before signing your application form. Electronic signatures are acceptable.
Send your completed and signed application form including any applicable attachments to SMSRCGrant-SubventionCSRIS@forces.gc.ca.
You will receive an acknowledgement email upon receipt of your application.
If your project is approved, an SMSRC representative will contact you to establish a funding agreement.
Successful applicants will be expected to submit reports on the status and results of their project. Additional details on what must be provided can be found under 'Progress and Final Reports' in the Application Guide.
Projects are expected to be completed as outlined in the original application. Recipients must proactively disclose any delays or changes to the date(s) of the project and/or submission of the final report. Any unspent funds must be returned to the SMSRC by cheque payable to the Receiver General for Canada.

If, as part of the project, you intend to conduct social science research, including but not limited to interviews or surveys with any people employed by or affiliated with DND/CAF, you are required to contact the Social Science Research Review Board (SSRRB) before you begin. Further details can be found in the Application Guide or by contacting SSRRB-CERSS@forces.gc.ca.

Privacy Notice Statement

The personal and organization information provided on this form is collected for the purpose of assessing an organization's application for grant funding. The Sexual Misconduct Support and Resource Centre (SMSRC) will use personal information to contact the organization as required to evaluate the application, audit compliance with grant provisions, and perform research or evaluation activities.

Personal and organizational information will be used for program administration, program evaluation, reporting, audit, research, and statistical analysis.

Information related to grant awards will be made available to the public. This will include the name of the organization/recipient, grant amount, and a project description.

Personal information will be treated and disclosed in accordance with the Privacy Act. For more information about your rights under the Privacy Act and your right to file a complaint pertaining to the handling of your personal information by DND/CAF, visit DND's Access to Information and Privacy page.

If you are concerned with the handling of your personal information by the Sexual Misconduct Support and Resource Centre, you have the right to complain to the Privacy Commissioner of Canada. Consult the details on how to submit a formal complaint regarding a federal institution (Privacy Commissioner).

For more information about the manner in which your information may be used, disclosed, and retained by DND, please see the Standard Personal Information Banks PSU 931 Accounts Payable.

I certify that:

I have read and understood all the elements of this application form.
The information contained in the application form is true, accurate and complete. I have attached the necessary additional documentation to my application, those being:
- authorization from the Québec government, if applicable;
- the two most recent years of the organization's financial statements and annual reports;
- proof of not-for-profit status; and
- the completed budget template.
I have read the relevant information provided for grant applicants regarding eligibility and funding conditions and confirm the organization and proposed project meet the eligibility criteria.
All budgeted items for this project are eligible expenses, and no budget items have already received funding from DND/CAF or the Government of Canada for that same fiscal year.
I accept that DND/CAF reserves the right to use whatever assessment process and selection criteria they deem necessary to evaluate this and other applications for grant funding, and that they have the sole discretion to make a determination as to whether the applicant is eligible under the program. The submission of an application form does not constitute a commitment on the part of the Minister of National Defence to award funding. The Minister of National Defence has the sole discretion to refuse or cancel this application process at any point in time.

___________________________

Name and title of applicant

___________________________

Signature of applicant

___________________________

Date

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Date modified:: 2024-10-29

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Community Support for Sexual Misconduct Survivors Grant Program Application Form

On this page

Part A – Organization information

Legal eligibility

Part B – Project evaluation

Part C – Budget

Part D – Declaration

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