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CSA Class Grant Program

CSA Class Grant Program
to support Awareness
(Educators and Organizations)

Application Form

Canadian Space Agency
Space Learning Program
6767 Route de l'Aéroport
Saint-Hubert, Québec
J3Y 8Y9 Canada

Instructions for completing this form

You must answer all fields as indicated. Your application will not be considered if there is missing or incomplete information.

Submit this application form with all other necessary documentation (proof of employment and citizenship for educators; institutions must provide a copy of their constitution).

For any additional information, please contact Jason Clement.

It is the applicant's responsibility to ensure that the application complies with all relevant federal, provincial/territorial and municipal laws.

Applicant Information

Applicant Designation:

For Quebec institutions

The applicant is subject to chapter M-30,
An Act respecting the Ministère du Conseil Exécutif

Given name of Applicant:

Family name of Applicant:

Name of Affiliated School or Organization:

Title and Position of Applicant within institution (i.e. educator, principal, consultant etc.):

Address:

City:

Province:

Postal Code: (ex : J3Y8Y9)

Telephone number: (ex : 450-123-4567)

E-mail address:

Confirm E-mail address:

I understand that I will be contacted to participate in pre-funding, post-funding, and follow-up (if applicable) evaluation surveys, regardless of the outcome of my application for funding.

Additional information

Description of space-relevant learning opportunity:

Please provide a short description of the learning opportunity to which you are applying for funding, including date title and location.

Purpose of attending the space-relevant learning opportunity:

Please provide a short description of the learning objectives which will be met through student or educator participation in this learning opportunity. List ways in which participation will ultimately increase awareness, knowledge, development and/or participation of Canadian youth in space-related disciplines/activities.

Linkage to program objectives:

Please describe how participation in this learning opportunity meets the objectives of the Space Awareness Grant program (see below for list of objectives).

Number of youth expected to benefit directly
from participation in learning opportunity:

Number of youth expected to benefit indirectly
from educator participation in the learning opportunity:

Project financial support

Outline any current and proposed future funding from other sources.

Source (Name of institution and funding program)

Amount

Pending /
Granted? ? ¹

For pending funds, date for announcement

Attach the notification letter

¹ Attach a copy of the notification letter. This should clearly identify the project name, funding agency and the result(s) of the demand. For awards that are pending, please indicate the expected date for the announcement.

Proposed cost associated with participating in the learning opportunity

Registration costs:

If travel is required to participate, please indicate which mode(s) will be used and cost:

If accommodation is required, please indicate the number of nights and number of people per room:

Please indicate if any meals are included in registration or accommodation costs:

Please indicate any additional costs required that fall into one of the eligible categories listed below:

Eligible costs are direct expenses associated with the delivery of the learning opportunity. Expenses including one or a combination of the items below, will be reimbursed subject to the applicant signing a Funding Agreement, in the form of a grant agreement, with the CSA.

Eligible Expenses

participation fees at conferences, committees and events;
travel;
accommodation and meals allowances;
training;
translation services;
tuition fees;
registration fees;
cost related to obtaining security clearance;
acquisition, development and printing of materials;
marketing and printing services;

Program Objectives

To increase awareness of Canadian space science and technology among Canadian youth and educators and their participation in related activities;
To provide learning opportunities to Canadian students and physicians in various space-related disciplines;
To support the operations of organizations dedicated to space research and education.

Privacy Notice

Necessary measures have been taken to protect the confidentiality of the personal information you provide. The information you provide is collected under the authority of the CSA Act. This information will be used to determine the eligibility of applicants for subsidy funding and may be used to subsequently provide you with information on other available learning opportunities.

Your personal information will be held in the CSA Personal Information Bank for the appropriate program for 2 years. It is protected under the Privacy Act. According to the Privacy Act, you have rights with respect to the information you submit. You may upon request:

Be given access to your file
Have incorrect information corrected or have a notation attached

For more information about your rights see Info Source. This is a Government of Canada publication available in major libraries, at government information offices and from constituency offices of federal Members of Parliament.

Space Awareness Grants Program Committee Request Assessment Form

Requirement	1 Does not meet requirement	2 Meets requirement
Relevance of initiative
Participation results in increased knowledge and/or awareness of Canadian youth in space-related content
Budgetary resources requested respect eligible costs
The extent to which the proposed event meets Program objectives.
The quality of the event in terms of the scope of Canadian space science and/or technology learning opportunities it offers youth
Transferability of the knowledge acquired by participating in the event to other students, educators or institutions, thus providing youth with formal or informal learning opportunities.