EmailMe Form - PSP Petawawa Jump Start Application Form

Name of Applicant *

Connection to the CAF *

CF1 Card Number *

Address *

City *

Postal Code *

Daytime Phone Number *

### - ### - ####

Email *

Number of Members in Family *

Number of dependents in family, between the ages 4-18 *

CHILD

Childs Name *

Date of Birth *

MM / DD / YYYY

Gender *

Address if different than parent or gaurdian

Program

Organization Receiving Funding *

Program Name *

Program Type *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

How many weeks will the program run? *

Facility where program will run? *

Is the organization HIGH FIVE registered organization? *

Key Contact Name *

Key Contact Phone *

### - ### - ####

Key Contact Email *

Program Registration Number *

REQUEST

Amount for Registraion Fees *

Amount for Equipment

Total *

ENDORSER

The endorser acts as an objective third party who is familiar with the family and in a professional position to assess the family, such as the following; Chaplain, Chain of Command, Social Worker, etc. The Endorser also agrees to be contacted by Jumpstart or PSP for follow up if required.

Endorser Name *

Phone Number *

### - ### - ####

Email *

Profession *

Submit your monthly cash flow/budget worksheet and letter of support from endorser.

Monthly cash flow/budget worksheet *

Letter of support from Endorser that verifies the amount of family income reflected in the Monthly cash flow/budget worksheet, and why the family should qualify to receive a grant from Jumpstart.

Letter of support *

The PSP Jumpstart Application process requires two approvals; one from National Recreation Services, and one from Canadian Tire Jumpstart. This is because our application process is different than the traditional Jumpstart application, and our funding criteria are specifically designed for our CAF community. *

*

I Understand