Research

Contributions Program: Privacy Research and Related Knowledge Translation Initiatives Funded by the OPC

Contributions Program
2012-2013

Application Form

(PDF Format)
(RTF Format)

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
Organization Representative 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

2. 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 in your organization persons to lobby on its behalf, or have you engaged consultants under contract to lobby on behalf of the 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 and address of the source, date and amount requested or awarded, and project title for which you are requesting funding.

Other Sources of Funding

Source
(Federal or Provincial Department or Agency)		 Project Title Amount Awarded/ Requested
 
 		  
 		  
 
 
 		  
 		  
 
Please provide additional information as Schedule B — Other Sources of Funding

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

Signature of Organizational Representative
Date

Please return to:

François Cadieux
Manager, Contributions Program
Office of the Privacy Commissioner of Canada
3rd Floor, Place de Ville, Tower B
112 Kent Street
Ottawa Ontario K1A 1H3
Fax: (613) 947-6850
Email: contrib@priv.gc.ca

PROTECTED WHEN COMPLETED