How to Use This Form

1.HOW TO USE THIS FORM 1. Save the Application Form to your own computer 2. Use Microsoft WORD to avoid formatting issues or corrupting the file 2.PITCH WITH PURPOSE 1. Less is more . This Application Form is the only document the TELUS Fund Board will receive to determine if they are interested in funding the project . Fit your responses within the allotted 5 Pages without shrinking the font size . Ensure your responses are aligned to the Evaluation Criteria found in the most recent Program Guidelines at www.TELUSFund.ca 2. Submit accurate information . You may be asked to provide supporting documents to confirm representations made in your submission 3.REMEMBER TO INCLUDE 1. Hyperlinks to additional content . Your response within the text box may be so well-aligned to the Evaluation Criteria that Board members want to explore additional information . Insert full and correct URLs. Don’t forget to include any login password 2. Letters demonstrating demand for your project, including: . A cash broadcast licence of at least 10% of the budget from a Canadian programming service1,2 . Backing from recognized national public and private organizations, community groups, and distinguished subject matter experts active in the subject area 3. Your digital signature . Sign the last page of the form and email both the completed MSWord and signed PDF version of the Application Form to [email protected]

1 Canadian programming services include CRTC-licenced Canadian over-the-air broadcasters (for example CBC, CTV, Global and City TV); Canadian specialty services whether Category A or Category B; Canadian pay television services (for example TMN and Family) and Canadian pay-per-view and video-on-demand services. The broadcast license term should expire no less than two years following delivery of content to all platforms and devices. All content must comply with the Canadian Association of Broadcasters’ Equitable Portrayal and Violence Code 2 The TELUS Fund in its sole discretion may agree to delay receipt or waive the requirement of written confirmation from a Canadian programming service for projects well-aligned to our mandate with otherwise strong backing from stakeholders active in the subject area Page 1 of a maximum of 5 pages PROJECT TITLE

TELUS FUND TOTAL FUNDING REQUEST

APPLICANT PARENT COMPANY NAME

CO-APPLICANT, IF APPLICABLE

4.PROJECT LOGLINE

5.LINK TO TRAILER 3

6.PROJECT SYNOPSIS

7.HEALTH AND WELLNESS INNOVATION Describe the health and wellness problem your project is attempting to address and why it matters. Include reference to underlying research of distinguished subject matter experts.

3 If a trailer is not yet available, you may link to other VISUAL content such as a demo, key interview footage, graphics, stills, screen shots, prototype, video walk through, etc. Page 2 of a maximum of 5 pages Page 3 of a maximum of 5 pages Describe why your project is an innovative approach to the problem and how it will make a difference in health and wellness outcomes. Reference existing solutions and underlying research to support your original approach.

8.REACH AND MEASURABLE SUCCESS Identify who you intend to reach with your project. Select all that apply. ☐ ☐ Age Pre-school Adults (<5) ☐ Children (5-12) ☐ Youth (13-17) (18+) ☐ Seniors (65+) Language ☐ English ☐ French ☐ Aboriginal Gender ☐ Female ☐ Male Describe the target audience for your project. Reference underlying market research and tests completed evidencing a strong understanding of this audience.

Describe the strategies you intend to use to reach this target audience. Identify commitments obtained for the promotion, broadcast, and international exploitation of your project. Identify the quantifiable ways you will measure audience reach and the impact on their health and wellness outcomes. Include projected performance targets.

9.LAUNCH AND COMMERCIALIZATION List line items in the project budget to support launch and commercialization4 Amount Allocated

TOTAL 10. TV PROGRAM SCHEDULE AND MILESTONES Milestones Date(s)

4 Line items may include for example campaign development, publicity, advertising, graphics, marketing, promotion, community screenings, social media manager, travel to markets, festival entrance fees, and the like Delivery to Broadcaster(s) First broadcast airing Licence Term 11. DM WORKS SCHEDULE AND MILESTONES Milestones Date(s)

Final Delivery Launch of Digital Media Work Site Maintenance Start and End Dates 12. PROJECT DESCRIPTION (SELECT ALL THAT APPLY) Television Program (TV Program) Digital Media Works (DM Works) ### episodes x ### minutes each Video: ### episodes x ### minutes each ### episodes x ### minutes each ### episodes x ### minutes each Website: ☐ Responsive Website TV Program Category5: ☐ Non-responsive Website ☐ Analysis, documentary -2a,b Game: ☐ Console ☐ Religion, spiritual condition -4 ☐ Online ☐ Education, recreation, leisure -5a,b ☐ Mobile ☐ Drama and comedy -7 Application: ☐ Internet ☐ Music and dance -8a,b,c ☐ Local network ☐ Variety and performance -9 ☐ Community/Social Media ☐ Game shows -10 ☐ Native to a device Describe ☐ Entertainment, reality TV -11a,b Other DM Work: Describe Devices: Operating System: Second screen synchronized experience: ☐ Television ☐ Windows ☐ IPTV ☐ Mobile phone ☐ iOS ☐ Other: Describe ☐ Smartphone/Computer ☐ Mac ☐ Tablet ☐ Android ☐ Game console ☐ Other: Describe ☐ Wearable ☐ Other: Describe 13. PROJECT HISTORY Summarize the project development history. Include links to existing creative materials for the TV Program (bible, outlines, scripts) and DM Works (wireframes, graphics, story boards, prototype).

5 Link to CRTC Definitions (opens new window): News 1, Reporting & Actualities 3, and Sports 6 are not eligible for funding 14. FINANCIAL STRUCTURE Financial Source(s) Type6 Confirmed TOTAL % TV % DM % Recoupable 1,000,00 1,000,00 1,000,00 TELUS Fund Y/N Advance 0 0 0

TOTAL: 100 100 100 % % %

Is this an Official Canadian co-production? ☐ No. If yes, ### % Canadian

15. TV PROGRAM

Key Positions Name(s) Canadian Links to prior similar projects Executive Producer Y/N Producer Production Manager Director

6 Grant, Tax Credits, Licence Fee, Equity Investment, Recoupable Advance, In-Kind, Deferrals Scriptwriter Performer / Host Interviewee(s) Subject matter Expert(s)

The TV Program will achieve a minimum of ### Canadian content points out of ### points7

16. DM WORKS

Key Positions Name(s) Canadian Links to prior similar projects Service Provider Y/N Producer Project Manager Creative Lead Technical Lead Writer Subject matter Expert(s)

The applicant(s) agree that no obligation is assumed or implied against TELUS Fund unless and until TELUS Fund enters into a written agreement with the applicant(s), if any, and then only as expressed in such agreement. The undersigned hereby releases TELUS Fund and its directors, officers, members, employees, administrators, agents and representatives from any liability for the loss, theft, damage or destruction of the documents and materials submitted with this application or for the unauthorized use or reproduction for reasons beyond TELUS Fund's knowledge or control. All risks associated with the transportation of the documents and materials submitted with this application are assumed by the applicant(s). The applicant(s) acknowledges that this application is not eligible if any part of this application is not completed and submitted in full. The applicant(s) hereby warrants that the information provided in this application is complete and accurate and that the signatory has the full authority to submit this application to TELUS Fund. The applicant(s) shall notify TELUS Fund immediately if and when any changes occur to any of the submitted documents or information and shall provide written details of any such changes. The applicant(s) hereby authorizes TELUS Fund to communicate any information in this application with any third party indicated in this application as a proposed or committed source of financing for this project. The applicant(s) acknowledges that the TELUS Fund has full discretion in administering its projects and in the application of the TELUS Fund Program Guidelines to ensure that funding is provided to those projects that meet the mandate and objectives of the TELUS Fund. The applicant hereby agrees that TELUS Fund is not responsible in any way for the holding or return of any materials submitted at any time in connection with the application and TELUS Fund retains the right to keep on file or destroy all materials submitted by applicants in support of their application.

Applicant Company for TV Program: Address: Telephone: E-Mail:

7 Link to CAVCO Guidelines (opens in new window) Broadcaster (In House) For Profit Company ☐ Not for Profit ☐ Broadcaster Affiliated ☐ ☐

Corporate Date: Signatory:

Name: Title:

Co- Applicant Company for DM Work (if different): Address: Telephone: E-Mail: Broadcaster (In House) For Profit Company ☐ Not for Profit ☐ Broadcaster Affiliated ☐ ☐

Corporate Signatory: Date:

Name: Title:

Primary Contact Name: Telephone: E-Mail: