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Contributions Program 2016-2017 - Call for Proposals: OPC Pathways to Privacy Research Symposium

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Application Form

I. IDENTIFICATION OF APPLICANT
Application Reference Number
(OPC Use Only)
Name of Organization
Previous Name (if changed in last year)
Address
City


 Province


 Postal Code
Telephone


 FAX E-mail
Name of Organization Representative
(Please also sign below under “V Signature”)


 Telephone E-mail
II. THE PROPOSAL

Attach your project proposal or proposals (See the Applicant's Guide for further detail).

III. DECLARATIONS
Conflict of Interest Act

1. Do you presently employ on your project team, a former federal public office holder who left public office in the last year, or a former minister who left office in the last two years?

YES > NO >

If YES, please ask that the person(s) contact the Conflict to Interest and Ethics Commissioner to obtain written confirmation that he/she is in compliance with the post-employment provisions of the Conflict of Interest Act.  Such confirmation must be provided to the Office of the Privacy Commissioner of Canada.

Values and Ethics Code for the Public Service

1. Do you presently employ on your project team a former federal public servant who left the federal public service in the last year?

YES > NO >

If YES, please ask that the person(s) contact the Deputy Head of the last federal government organization where he/she was employed, and obtain written confirmation that he/she is in compliance with the post-employment provisions (notably Chapter 3) of the Values and Ethics Code for the Public Service. Such confirmation must be provided to the Office of the Privacy Commissioner of Canada.

Lobbying Act

1. Do you presently employ on your project team persons to lobby on your organization’s behalf, or do you plan on engaging your project team consultants under contract to lobby on behalf of your organization?

YES > NO >

2. If YES, are the persons lobbying on your organization's behalf (employed by the organization or consultants under contract) registered pursuant to the Lobbying Act?  Such confirmation must be provided to the Office of the Privacy Commissioner.

YES > NO >
IV. OTHER SOURCES OF FUNDING

If you have received or are applying for project funding for this project through any other federal or provincial government department or agency, please provide the name of the source, date and amount requested or awarded.

Other Sources of Funding
Name of the Other Source(s) of Funding Date of Funding Request(s) Amount(s) Requested or Awarded (CND $)
     
     
     
Please provide additional information in Schedule B under “Other Sources of Funding”.
V. SIGNATURE

This declaration must be signed by a person with signing authority within the organization.

   
         

 

             
                  

Signature of Organizational Representative

             
   
     
         

 

            
                 

Date

            
   

Please return to:

Office of the Privacy Commissioner of Canada
Care of: Contributions Program
30 Victoria Street
Gatineau, Quebec  K1A 1H3
Email: contrib@priv.gc.ca

PROTECTED WHEN COMPLETED

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