Application Form

Name of program:


Address of program:


Province/Territory:
Alberta Saskatchewan Manitoba Northwest Territories

Contact person:


Area code and phone number:


Email address:


Brief description of program objectives (including target group) (max 100 words):


What do you believe makes this program innovative? (max 150 words)


What challenge(s) led to the need for the innovation? (max 100 words)


What outcomes did you expect of this program? (max 100 words)


How do you know if these outcomes have been achieved? (max 100 words)


What lessons have you learned in attempting this innovation? (max 100 words)


What is the applicability of this innovation to other settings? (max 100 words)