Language preferred for correspondence / Langue de correspondance:
Name of government body applying for funds: 
Address
Street 
P.O. Box 
City 
Province or Territory 
Postal Code 
Contact Name 
Title 
Telephone 
Fax 
E-mail Address 
Title/Case Identifier
Amount Requested 
Start Date
DD/MM/YY
Completion Date DD/MM/YY
I acknowledge that should a project be approved, I will be required to enter into a formal agreement which will outline the terms and conditions.
Name of authorized Organization Officer 
Title 
Telephone 

Fax 

E-mail Address
Signature 
Date 

Please forward your completed project proposal to:
Policy Planning Directorate
Programs Branch
Department of Justice Canada
280 Wellington Street, 6th Floor
Ottawa, Ontario K1A 0H8
Fax: 613-941-5446