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Natoaganeg Entrepreneurship Fund Application

PARTICIPANT INFORMATION FORM

The following information is required by Natoaganeg Community Development Centre for funding purposes. All applicant’s information must be provided. This information is highly confidential and will be utilized to determine eligibility for Natoaganeg’s Entrepreneurship Fund (NEF).

Checklist

Provided proof of membership within the Natoaganeg First Nation Band
Provided documentation if received other funding from different funding sources and/or Natoaganeg
Provided proof of Grade 12 Diploma or proof of Adult Basic Education (If applicable)
Provided proof of post – secondary education, college/university degree/certificate (If applicable)
Provided a written letter
Provided a quote of all tools/equipment and/or consultant(s)
Provided an updated resume
Provide proof of primary business ownership
Read all documentation provided (Natoaganeg Entrepreneurship Fund Guidelines 2021 and Guide for Entrepreneurs).

Clicking the Save & Continue button on any section of the form will send you a link by email that allows you to complete your application within the next 30 days. Otherwise, click the Next button to continue.

Natoaganeg Entrepreneurship Fund Application Form

Step 1 of 7

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Consent to Release Information

Consent(Required)

I understand that all information provided will be used by the Natoaganeg Community Development Centre to determine eligibility for the Natoaganeg Entrepreneurship Fund. This also includes Natoaganeg Community Development Centre reaching out to other sources of funders. This authorization will remain in effect UNLESS I give written instruction to cancel the authorization.

Signature of Applicant(Required)

Date(Required)

MM slash DD slash YYYY

Personal Information

Social Insurance Number (SIN)

Date of Birth

MM slash DD slash YYYY

Title

Mr.

Ms.

Mrs.

Miss

Gender

Female

Male

Unspecified

Name

First Name Middle Name(s) / Initials Last Name

Common Name (if applicable)

Aboriginal Group

Registered Indian

Non-status Indian

Métis

Inuit

Registration / Band Number

First Nation Name

Marital Status

Married or Equivalent

Single

Separated

Divorced

Widowed

If married or equivalent, spouse's name

Dependent Children

Yes

Children's ages

Do you consider yourself to have a disability?

Yes

Please specify your disability

Other than Aboriginal do you belong to a visible minority group?

Yes

Are you currently a Social Assistance recipient?

Yes

Labour Force Attachment

Unemployed

Student

Employed Full-time

Employed Part-time

Self-Employed

Other

If other, please specify

Contact Information

Address

Street Address Address Line 2 City Province Postal Code

Other Address

Mailing Address

Other Address, specify

Specify Mailing Address or Other Address (if applicable)

Home Phone

Cell Phone

Message Phone

Emergency Contact Name

Emergency Contact Number

Income

Are you currently an Employment Insurance Claimant?

Yes

If yes, Claim Type

Gross Weekly Rate: $

Number of Weeks Entitled

Expected End Date

Educational Level

Education (Choose all that apply)

No formal education

Up to Grade 7-8 (Secondary I-II)

Grade 9-10 (Secondary III)

Grade 11-12 (Secondary IV-V)

Secondary School Diploma or GED

Some post-secondary training

Apprenticeship / trades certificate or diploma

College, other non-university certificate or diploma

University certificate or diploma

University - Bachelor Degree

University - Masters Degree

University - Doctorate

Province / Territory in which highest level of education AND year attainted

Business Questions

These questions only apply to business owners.

Are you the Primary business owner?

Yes

If you are already a business owner, how long have you been in business?

Is your business registered for employment?

Yes

Is your business registered?

Yes

If yes, what is the business number?

Do you rent a facility / building / equipment?

Yes

If yes, where?

How many people are employed within your business? How many of those employees are Indigenous?

How many of those employed are from Natoaganeg?

Have you ever occasionally employed people? If so, were they:

Non-Registered (spouses)

Registered

Non-Indigenous

Registered in a different community?

Are you currently employing anyone?

Yes

When were they employed?

During the last six months

During the last year

Were they:

Full Time

Part Time

Seasonal

Business Financials

Total cost of business start up: $

Source of Fund - Must provide proof of approved financing from all sources on the next page.

Amount of client cash - Equity Amount $

Loans: Institution Amount $

Grants: Institution Amount $

Total $

If you received more than one loan or grant from an institution, please list below:

Documentation

Proof of Membership within the Natoaganeg First Nation Band

Drop files here or

Max. file size: 64 MB.

Documentation if received other funding from different funding sources and / or Natoaganeg

Drop files here or

Max. file size: 64 MB.

Proof of Grade 12 Diploma or proof of Adult Basic Education (if applicable)

Drop files here or

Max. file size: 64 MB.

Proof of post-secondary education, college / university degree / certificate (if applicable)

Drop files here or

Max. file size: 64 MB.

Provided a written letter

Drop files here or

Max. file size: 64 MB.

A quote of all tools / equipment and / or consultant(s)

Drop files here or

Max. file size: 64 MB.

An updated resume

Drop files here or

Max. file size: 64 MB.

Proof of primary business ownership

Drop files here or

Max. file size: 64 MB.

Get In Touch!

Call Us

506-627-4600

47 Church Rd, Eel Ground, NB E1V 4E6

Email Us

nsacobie@natoaganegcdc.com

Hours

Monday - Thursday

9:00 AM – 4:00 PM

Friday

9:00 AM – 12:00 PM

Saturday - Sunday

Closed

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