Politique Nationale De La Ruralité

Structured Projects to Improve Living Environments Support Policy

BROME-MISSISQUOI PACT 2018

SUBSIDY APPLICATION FORM IN REGARDS TO THIS FUND, A REFERENCE GUIDE IS AVAILABLE ON THE MRC WEBSITE. IT IS STRONGLY SUGGESTED THAT YOU CONSULT THIS GUIDE. WWW.MRCBM.QC.CA IDENTIFICATION Name of organization

Type of organization (fill in the right box)

Cooperative (except work and financial Municipality Non-profit organization cooperatives)

Address

Town Postal code

Resource person

Resource person’s phone number E-mail

PROJECT DESCRIPTION Project Title: Project’s objectives :

Project description : Summary of project

Targeted municipalities MRC Brome-Missisquoi BROME-MISSISQUOI PACT – SUBSIDY APPLICATION FORM 2018

Abercorn Brigham Bedford (township) Bolton-Ouest Dunham Bedford (town) Brome Cowansville Farnham Bromont East Farnham Notre-Dame-de-Stanbridge Lac-Brome Frelighsburg Pike River Sutton Stanbridge East Sainte-Sabine Saint-Armand Stanbridge Station Saint-Ignace-de-Stanbridge

Project timeline - Beginning End date : date : PROJECT’S REPERCUSSIONS Describe how your project fulfills an identified need of the community or is an answer to a strategic orientation stemming from an existing municipal or regional strategic plan? (Please indicate also if your project is included in a municipal or regional action plan)

Who are the partners for the project?

What will be the project’s benefits in regards to the environment, and social and economic development?

2 BROME-MISSISQUOI PACT – SUBSIDY APPLICATION FORM 2018

What actions will be taken to insure the viability of the project after it has been completed? (Financing, structure, management, partnerships, etc.).

ORGANIZATION’S RELEVANT EXPERIENCE Describe previous experiences and expertise that might be pertinent to the project.

COMMUNITY INVOLVEMENT Numbe Type of implication Hourly rate Estimated time Total r Regular volunteer work $15 Volunteer work for services normally executed by a paid professional (legal, $30 accounting, translation, etc.) Other :

BUDGET

Total cost EXPENSES Description of expenses (taxes included)

Human resources

Professional fees

Renovations Equipment (purchased or rented) Purchase of land or building Rentals (land, building, space) Inventory Publicity- Communications Other (specify)

TOTAL Description of financial Confirmed REVENUS Total financing partners amount Down payment Municipality

Provincial subsidy Federal subsidy Other (specify) Brome-Missisquoi Pact TOTAL

PROMOTER’S DECLARATION  I attest that the information included in this application form as well as all attached documents are true to form.  I understand that this request will be evaluated by one or several evaluation committees who will present recommendations.  These recommendations will be submitted to the MRC mayors’ council. The MRC will make its final decision at its monthly meeting held on March 20th 2018.  I understand that the MRC’s decision will be communicated by e-mail. x Signature Name (block letters) Date DEADLINES To submit an application form including all resolutions:26th of January 2018 by 4:30 p.m. at the MRC. (Requests postmarked on the 26th of January will be accepted).

To request a municipal resolution of moral or financial support: at the latest the 13th of November 2017 at noon.

All decisions concerning subsidy requests will be revealed after the 20th of March 2018.

Send all documentation needed to: Brome-Missisquoi Pact MRC Brome-Missisquoi 749, Principal street, Cowansville, J2K 1J8 A copy of the application form must also be sent to [email protected] by the 26th of January 2018 before 4:30 p.m. DOCUMENTS TO INCLUDE WITH THE APPLICATION FORM SENT THROUGH THE MAIL:

COMPULSORY : • A copy of the organization’s letters patent if this is a first time request • Copies of all resolutions or letters describing all material and financial contributions of partners towards the project. • A resolution of support from the municipality in question is necessary. • A resolution from the organization’s board designating the project’s resource person and the person responsible for signing, in the name of the organization, all documents, including the agreement.

OPTIONAL: • All documents that applicants judge pertinent to present to the evaluation committee (financial statements, photos, bids, plans, letters of reference, letters of 5 BROME-MISSISQUOI PACT – SUBSIDY APPLICATION FORM 2018 support, business plan, C.V., strategic plan, etc.).

N.B : HANDWRITTEN REQUEST WILL NOT BE ACCEPTED.