Application Form 2012

[ PDF Version PDF ]

To apply for funding for a Yukon Drop the Pop Healthy Eating project, please complete this application form and e-mail it Kim.Neufeld@gov.yk.ca and Lorna.Arsenault@gov.yk.ca or fax it to 867-456- 6502. 

Application Deadline: January 17, 2012

What must be filled out:

  1. Application Form including budget estimate (column A)
  2. Drop the Pop Activity Report Form that includes column B of budget form.

Not mandatory:

  1. To qualify for the School Award the Activity Report Form must be submitted by March 9, 2012.

** = Mandatory Fields

1. SCHOOL **:
  

  Contact Person**:
  

  Contact Email Address**:
  

2. AMOUNT OF FUNDING**:

  School funding will be based on student  population and will be distributed as follows:

   Daycares: $300
   a. 0 - 49 Students: $400
   b. 50 - 100 Students: $750
   c. 101 – 200: $1000.00
   d. more than 200: $1250.00

3. WHO WILL YOUR PLANNING PARTNERS IN THIS PROJECT BE?
  (parents, elders, students, stores, nutritionist, etc)
  

4. DESCRIBE YOUR PROJECT ACTIVITIES**:
  (max 350 words)
  Project Description:
  (Must include an educational component)
  

5. BUDGET:    A: Estimate *    B: Final Report **

BUDGET
(use extra paper/forms if needed)

Drop the Pop Budget 1

What You Actually Spent 2
Complete and re-send by March 9th

Explanation: describe all costs, where applicable.

Project Title(s)**:

A. Materials and Supplies - Foods

$

$

Comments: please specify the kinds of materials you are buying or will be producing as part of your project (foods – e.g. milk, juice, water, fruit, etc)

$

$

$

$

A. Total Materials and Supplies Costs:

$

$

B. Other Costs

$

$

Comments:  prizes, equipment, advertising (any other cost not food related)

 

 

 

$

$

$

$

B. Total Other Costs

$

$

C.TOTAL A+B=C**

$

$

 



1 What you estimate you will need to run your Drop the Pop Project.

2 What you actually spent on the project. Do not round numbers. Report exact amounts spent.  No receipts are required, but they should be kept in case of an audit.

Are you interested in applying for a School Award?
Simply complete the Drop the Pop Activity Report Form and email to Lorna Arsenault or fax to 867-456-6502.

Completed award forms are due by March 9th, 2012.