Rural Connections Broadband Program Application

Application for
Rural Connections Broadband Program

Table of Contents

General Information Form

In completing the application submission, refer to the Rural Connections Broadband Program Application Guideline/Instructions document.

Note: Text boxes will expand to accommodate additional narrative.

In addition to the General Information form, applicants must complete the following Schedules:

• Schedule 1 - Business Case
• Schedule 2 - Gap Analysis
• Schedule 3 - Technical Plan
• Schedule 4 - Cost Summary
• Schedule 5 - Outreach and Awareness Plan
  

1. Name of Lead Municipality: ____________________________________________

2. Lead Municipality Contact Information: ___________________________

3. Collaborating Municipalities: ___________________________________

4. Proposal Title: ______________________________

5. Amount Requested from Rural Connections (maximum $1 million): _____________

6. Proposal Synopsis: ______________________

7. Total Project Costs Table:
   

   Total Project Costs This chart should be filled in after completing Schedule 4 - Cost Summary.	Eligible Expense ($)
   Consulting Fees
   Design Engineering
   Infrastructure (existing and new) - vertical real estate, equipment, network management software
   Project Management (max. 10% of eligible costs)
   Outreach/Awareness and Public Sector Access (required to allocate 5% of eligible costs to this component)
   Miscellaneous - surety costs, plaque expense
   Other
   Total Estimated Eligible Costs (A)

8. Sources of Fudning and Partners
   Insert value for anticipated contributions - cash and in-kind - to cover the Total Estimated Eligible Costs (A) identified in the chart above.
   

9. Sources of Proposed Funding	Cash Contribution	Estimated Value of in-kind Contributions	Total Projected Funding Contribution
   Lead Applicant Municipality	$	$	$
   Partners Internet Service Providers(s)	$	$	$
   Other Private Sources	$	$	$
   Sub-Totals	$	$	$
   Funding Requested from Rural Connections (1/3 of project total to a maximum of $1 million)			+$
   Total Eligible Project Costs (B) - must equal (A) from Chart 7 above			$

10. Previous Broadband Funding: _____________________

Confidentiality, Consent and Certification

Confidentiality
Applications and supporting material submitted to the Ministry of Agriculture, Food and Rural Affairs will be subject to the Freedom of Information and Protection of Privacy Act (Ontario). Any information submitted in confidence should be clearly marked "CONFIDENTIAL" by the applicant. Inquiries about confidentiality should be directed to the Ministry of Agriculture, Food and Rural Affairs.

Consent
Successful partners/applicants consent to having their names, funding amounts and short summaries of their projects and results made available to the public.

Certification
I hereby certify to the Province of Ontario that the application and supporting documentation are true and complete in all respects.

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Signature of Authorized Representative of Lead Municipality:

Name (print): ________________________________

Title: ________________________________

Signature: ________________________________

Date: __________________

Schedule 1 - Business Case

1.1 Business Rationale: _________________________
1.2 Estimated Timelines for Project Milestones
Based on government fiscal year:

Q1 = April - June
Q2 = July - September
Q3 = October - December
Q4 = January - March

Milestone Descripton	08	08	08	08	09	09	09	09	10	10	10	10	11	11	11	11
	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
Business Case, Technical Plans, RFP
Engineering/Design
Project Implementation
Construction
Awareness/Outreach Activities
Project Completion
Final Report

Schedule 2 - Gap Analysis

Attach one (1) copy of the completed spreadsheet to each of the three application copies to be submitted. Also, include an electronic Excel version (not pdf ) with your electronic application.

2.2 Summary Demographic Description of Area

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Schedule 3 - Technical Plan

3.1 Description of Proposed Network

_________________________________

_________________________________

_________________________________

3.2 Network Configuration

_________________________________

_________________________________

_________________________________

3.3 Network Characteristics

_________________________________

_________________________________

_________________________________

3.4 Equipment Details

_________________________________

_________________________________

_________________________________

3.5 Construction Schedule
Below is a sample table to illustrate some of the activities.

3.6 Rick Factors
Identify any potential risks and mitigation paths associated with the construction and technical aspects of the project.

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Schedule 4 - Cost Summary

Complete the Cost Summary identifying the proposed project costs. Note the cells coloured red represent ineligible costs. These cells cannot be changed.

Submission Instructions
A printed copy of the spreadsheet must accompany the application. Additionally, attach an electronic copy in the original Excel format (not pdf) to the electronic application.

Schedule 5- Cost Summary

5.1 Small and Medium Enterprise Outreach and Awareness Plan

_________________________________

_________________________________

_________________________________

5.2 Small and Medium Enterprise Outreach and Awareness Plan
Deliverables, Timelines and Budget

5.3 Public Outreach and Awareness Plan

_________________________________

_________________________________

_________________________________

5.4 Public Outreach and Awareness Plan
Deliverables, Timelines and Budget

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5.5 Public Sector Organizations

_________________________________

_________________________________

_________________________________

5.6 Public Access Point Strategy

_________________________________

_________________________________

_________________________________

5.7 Public Sector Access
Deliverables, Timelines and Budget

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