Nova Scotia Climate Change Adaptation Fund (CCAF)
2013-14
APPLICATION FORM
BEFORE YOU START, PLEASE REMEMBER:
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Review the Climate Change Adaptation Fund Form before proceeding.
Use the document provided to fill in and submit your application electronically—this is mandatory.
Other information that is relevant to the project application can be attached in the email. Clearly identify
any attached documents in the space provided at the end of this form.
Incomplete applications will automatically be considered ineligible at the application deadline. Applicants
are advised to submit their proposal early and request that the Fund Coordinator review the document to
ensure it is complete.
The Fund Coordinator reserves the right to contact the proponent at any time during the evaluation
process for clarification or obtain additional information.
CONFIDENTIALITY STATEMENT
All information submitted to the Government of Nova Scotia as part of an application to the Climate Change Adaptation Fund will be governed by
the provisions of the Freedom of Information and Protection of Privacy Act (http://nslegislature.ca/legc/statutes/freedom.htm). Any information
submitted will be retained by the Government of Nova Scotia.
1. Project Title: Provide a title for the proposed project. Choose a title that is short, concise, and can be easily used to
reference the project.
2. Applicant Information: Complete the section with the information as requested. Partnering organizations are
defined as any organization that has confirmed contribution to the project financially or in-kind. If there is more
than one partnering organization copy the chart as required.
Applicant
Contact Person & Title:
Organization:
Address:
Phone:
Fax:
Email:
[NS Climate Change Adaptation Fund 2013-14]
Partnering Organizations
Contact Person & Title:
Organization:
Address:
Phone:
Fax:
Email:
3. Project Description: Provide a brief (200 words or less) description of the project. It should be clear and concise and
provide an easily understandable overview of what you are proposing. This will be used to communicate the project
to a third party. This description should be carefully crafted to accurately represent the proposal to a non-technical
audience.
4. Project Focus: Indicate with an (X) the main focus of the project. If there is
more than one focus, mark multiple boxes.
Agriculture
Human Health
Communities
Mining
Eco-systems
Costal Zones
Energy
Policy
Fisheries
Decision Making
Food Supply
Landscape Hazards
Forestry
Infrastructure
Tourism
Planning
Transportation
Forests
Other (please specify)
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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[NS Climate Change Adaptation Fund 2013-14]
5. Project Value: A project’s value will be evaluated on the ability to provide solid objectives and deliverables, exhibit
innovative thinking, and identify benefits that may flow from end results and/or findings. Consider the following
questions when preparing the following sections:
 How will this project fill an information gap in Nova Scotia related to adapting to climate change?
 How will this project prepare Nova Scotians to make better decisions regarding climate change?
 What threat(s) will the project address?
 What opportunities will the project address?
 Who will benefit from the information made available through this project?
 How will other organizations use the information, products, or services made available after the project is
complete?
5.1. Objectives: Both short-term and long-term objectives/goals should be identified as those within the timeframe of
the project and those to be achieved after the project has been completed. Link objectives back to those of the
Climate Change Adaptation Fund?
5.2. Deliverables: Provide details on the specific deliverables of the project. This will include
results/accomplishments/milestones to be achieved throughout the project. Be clear and tangible; deliverables will
be used to measure project accountability and success. Show relationship of deliverables to project objectives.
5.3. Innovation: Address how your project takes a new and/or innovative approach to addressing climate change
adaptation in Nova Scotia (ie, has the project been done before? If so, how is your project different and why is this
approach necessary?).
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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[NS Climate Change Adaptation Fund 2013-14]
5.4.Benefits: Explicitly state the project specific and post-project (both short- and long-term) economic, social, and
environmental benefits to be derived from the project. Be sure to include potential disadvantages as well. State the
consequences (if any) of not undertaking this project.
6. Organizational Background: Outline your organization’s qualifications and experience to perform the proposed
project. Include areas such as project management, technical knowledge, financial management, and any past
experience with similar projects.
7. Project Work Plan: The project work plan provides the details of how you plan to meet the goals and objectives
outlined in section five. Be as detailed as possible, and be sure to provide all the information that is requested.
Projects must be completed by March 31st, 2014.
7.1. Project Time Frame, Methodology and Deliverables: Provide outline of milestones (key dates/timing) of the
project plan as they relate to the objectives and deliverables as established in section five. Every project should
clearly indicate a start and finish date or time frame. Also detail the methodology proposed to be used to complete
the project. This should include a detailed description of the activities to occur as related to the time frame. If
providing a Gantt chart or other visual representation, be sure to provide an explanation. The deliverables of the
project include what will exist at the end of the project. Applicants should detail the proposed
technology/equipment, processes, benefits, etc. that will be in place as a result of the project.
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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[NS Climate Change Adaptation Fund 2013-14]
7.2. Management Structure: Clearly indicate the roles and responsibilities for the project, referencing the project team
as detailed in section 5. If more than one organization will be involved (partners, contractors, etc.) define the
relationship as they relate to the project. Provide an organizational chart if possible. Use this space to describe the
capacity of the applicant and partners to complete the project as proposed. Include the CV and/or resume of key
project participants. Please list these at the space provided at the end of the document.
7.3. Monitoring and Evaluation: All projects receiving funding must provide details on how they plan to ensure funds
are used appropriately. Indicate how you will ensure accountability in the management of the project. Include a
strategy to monitor and assess project progress as it relates to the goals and objectives identified in section seven
and the time frame/methodology detailed in section 8.1. Detail how you plan to measure the success of the project
and how you will ensure all funding partners are well informed of the project progress.
7.4. Community Involvement: If the project as proposed will result in an impact in the community, indicate that
stakeholders have been consulted by providing letters of support, and how they will continue to be involved
throughout the project.
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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[NS Climate Change Adaptation Fund 2013-14]
7.5. Other Relevant Information: Use this space to provide information relevant to the project that was not detailed in
the above section. Include information such as: Will this project require regulatory approval? (e.g. Environmental
assessment) If so, state the details and the timeline required to obtain approval.
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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[NS Climate Change Adaptation Fund 2013-14]
8.
Project Budget: All financial information related to the project must be presented in this section accurately. All
tables must be completed or the application will be consider ineligible. Please note the Province reserves the right
to perform a credit check on the project proponent and/or partnering organizations and/or require financial
security (performance bond, letter of credit, etc.).
8.1. Project Expenses: Provide a summary of the project expenses using the following table. Create new rows for
expense categories if necessary. Please review the Adaptation Fund Guideline for details on eligible costs, funding
guidelines and other requirements. Remember to provide detailed listings of all expenses.
Expense Category
Details
Climate
Change
Adaptation
Fund Request
Contributor 1 (name)
Contributor 2 (name)
Cash
In Kind
Cash
In Kind
$
$
$
$
Total Project
Costs
$
$
Human Resources
(salary/wages, etc.)
Professional Fees
(technical,
consulting, legal,
contracting, etc.)
Equipment/Supplies
Equipment Rental
Administration
Costs
Travel Costs
Other (please
specify)
Totals
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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[NS Climate Change Adaptation Fund 2013-14]
8.2. Funding Source Details: Summarize the total amount to be contributed to the project from each partnering
institution or source including any government department, agency, or Crown Corporation (federal, provincial,
municipal). This will include the total request to the Climate Change Adaptation Fund. Indicate if this funding has
been confirmed and provide proof (Letter of support, contribution agreement etc.) Please note other funding
agencies may be contacted to confirm support, or to request details of the funding program applied. Include
funding history for earlier phases of the project (if applicable). Create new rows for additional funding sources if
necessary.
Funding source
Contact Name &
Information
Funding Phase
Total Contribution ($)
Climate Change
Adaptation Fund
(indicate request)
Confirmed?
(Y/N)
N
Contributor (name)
Total
9. Attachments: Please list the attached documents supplementing this application in the space provided. Include
the file name and description.
File
No.
File Name
Description
Proposal Submission: Submit the completed proposal and all attachments by May 17, 2013 electronically to:
adaptationfund@gov.ns.ca. If you are unable to submit electronically, please contact the Fund Coordinator:
Alexa Vodicka, Climate Change Adaptation Fund Coordinator
Climate Change Unit| Nova Scotia Department of Environment
5151 Terminal Road, 2nd floor | Halifax, NS B3J 2P8
Ph: (902) 424-0737 / Fax: (902) 424-0528
You will receive an acknowledgement that we have received your application via e-mail. For assistance with your application, or for any questions
you may have, please contact us.
For submissions or information on CCAF application, please contact adaptationfund@gov.ns.ca
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