Nunavut Harvest Support Program

Nunavut Harvester Support Program

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Personal Information / ᐃᕝᕕᑦ ᒥᔅᓵᓄᑦ ᑐᑭᓯᐅᒪᔾᔪᑎᔅᓴᑦ
All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ
What will you use the funds for? (check all that apply) / ᑭᓱᒧᑦ ᑮᓇᐅᔭᑦ ᐊᑐᖅᑕᐅᓂᐅᓴᕙᑦ? (ᐅᓇᓂ ᓇᓗᓇᐃᕐᑕᐃᓐᓇᕆᓗᒋᑦ ᐱᔾᔪᑎᒋᔪᒪᔭᓐᓄᑦ)*
- Small Equipment / ᒥᑭᔫᑏᑦ ᓅᑦᑐᖅᓯᐅᑏᑦ
- Safety Equipment / ᓱᓇᒃᑯᑏᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑏᑦ
- Disaster Relief / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ
- Insurance Coverage
Please enter your name / ᐊᑏᑦ ᑎᑎᕋᙳᐊᑕᕐᓯᓐᓇᕈᒃ*
First Name / ᐊᑏᑦ Last Name / ᐊᑎᕈᓰᑦ
Date of Birth / ᑎᑎᕐᓯᕕᒋᓗᒍ ᐅᑭᐅᑎᑦ ᓇᓛᓃᕝᕕᖏᑦ (You must be 16 years or over to apply / 16ᓂᑦ ᐅᑭᐅᖃᕆᐊᖃᖅᑐᑎᑦ ᐅᖓᑖᓂᓘᓐᓃᑦ ᑐᔅᓯᕋᐅᓯᐅᕈᒪᒍᕕᑦ)
Day / ᐅᓪᓗᖅ*
Month / ᑕᖅᑭᖅ*
Year / ᐊᕐᕌᒍ*
Select your community / ᓂᕈᐊᕆᑦ ᓄᓇᖃᕐᕕᓐᓂᒃ*
NTI number / ᓄᓇᕗᑦ ᑐᙵᕕᒃᑯᓐᓂᑦ ᐃᓚᒋᔭᐅᔾᔪᑏᑦ ᓈᓴᐅᑖ*
Do not include dashes or spaces with your NTI number / ᐱᖃᓯᐅᔾᔨᑦᑕᐃᓕᒋᑦ ᑎᑎᖅᓯᒪᔪᓂᑦ ᓈᓴᐅᑎᐅᙱᑦᑐᓂᑦ ᐊᒻᒪᓗ ᑲᑎᙵᑎᑦᑕᐃᓐᓇᕆᓗᒋᑦ ᓄᓇᕗᑦ ᑐᙵᕕᒃ ᑎᒥᖓᓄᑦ ᓈᓴᐅᑎᕆᔭᑎᑦ
Email / ᐃᕐᖐᓈᖅᑕᐅᑖ
Daytime Phone Number / ᐅᖄᓚᐅᑖ*
Mailing Address / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᑐᕌᕈᑖ*
House number / ᐃᒡᓗᕕᑦ ᓈᓴᐅᑖ P.O Box / ᑎᑎᖅᑲᓂᐊᕐᕕᖓ Community / ᓄᓇᓕᒃ Province / ᓄᓇᓕᐅᑉ ᐊᕕᒃᑐᖅᓯᒪᓂᕆᔭᖓ Postal Code / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᓇᓗᓇᐃᒃᑯᑕᖓ
Address must be in Nunavut / ᓄᓇᕗᒥᐅᑕᐅᔭᕆᐊᓕᒃ
SIN Number / ᐃᖅᑲᓇᐃᔭᖅᑐᕐᓯᐅᑦ ᓈᓴᐅᑏᑦ*

Applicants are asked to provide their SIN as part of the application for funding under the Nunavut Harvester Support Program. QIA is actively working to determine if recipients are required by Canada Revenue Agency to report this grant as taxable income. If this is the case, QIA must issue a T4A to each recipient. If it is determined later that QIA is not required to issue T4As, QIA will remove your SIN number from our records. / ᑐᔅᓯᕋᖅᑐᑦ ᑐᓂᓯᖃᑦᑕᖁᔭᐅᕗᑦ ᐃᖅᑲᓇᐃᔭᖅᑐᕐᓯᐅᑎᖏᑕ ᓈᓴᐅᑎᖏᓐᓂᒃ ᐃᓚᒋᔭᐅᓪᓗᓂ ᑐᔅᓯᕋᐅᑎᖏᓐᓄᑦ ᑮᓇᐅᔭᓂᑦ ᑖᒃᑯᓇᙵᑦ ᐃᓱᒫᓗᓇᕐᓯᓯᒪᑎᓪᓗᒍ ᐊᖑᓇᓱᑦᑎᓄᑦ ᐃᑲᔫᑎᓂᑦ. ᕿᑭᖅᑕᓂᒃᑯᑦ ᐃᖅᑲᓇᐃᔮᖃᓪᓚᕆᒻᒪᑕ ᑐᑭᓯᓇᓱᑦᑐᑎᒃ ᐃᑲᔫᓯᐊᖅᑖᖃᑦᑕᖅᑐᑦ ᑲᓇᑕᒥ ᑮᓇᐅᔭᓕᐊᒥᓂᕐᓄᑦ ᐅᑎᖅᑐᔅᓴᓕᕆᔨᒃᑯᓐᓂᑦ ᑐᓴᖅᑎᑦᑎᒋᐊᖃᕋᔭᕐᒪᖔᑕ ᑖᒃᑯᐊ ᐃᑲᔫᑏᑦ ᐃᓚᒍᑕᖏᓐᓄᑦ ᑮᓇᐅᔭᓕᐊᖑᒻᒪᖓᑕ. ᑕᐃᒪᐃᓐᓂᐊᖅᑲᑦ, ᕿᑭᖅᑕᓂᒃᑯᑦ ᑐᓂᓯᔭᕆᐊᖃᕋᔭᕐᖓᑕ ᓇᓕᖅᑲᓂᑦ T4A ᑎᑎᕋᖅᑕᐅᔪᔅᓴᓂᑦ ᐊᑐᓂᑦ ᐃᑲᔫᓯᐊᖅᑐᓄᑦ. ᑐᑭᓯᔭᐅᑉᐸᑦ ᑭᖑᓂᐊᒍᑦ ᕿᑭᖅᑕᓂᒃᑯᑦ ᑐᓂᓯᔭᕆᐊᖃᔾᔮᖏᓐᓂᖏᓐᓂᒃ ᓇᓕᖅᑲᓂᑦ T4A ᑎᑎᕋᖅᑕᐅᔾᔪᑎᔅᓴᓂᑦ, ᕿᑭᖅᑕᓂᒃᑯᑦ ᐲᔭᐃᓂᐊᖅᑐᑦ ᐃᖅᑲᓇᐃᔭᖅᑐᕐᓯᐅᑏᑦ ᓈᓴᐅᑎᖏᓐᓂᒃ ᑎᑎᖅᑲᖁᑎᑦᑎᓐᓂ.
Household Information / ᐃᓪᓗᒥᐅᖃᑎᒌᑦ ᖃᓄᐃᓕᖓᒻᒪᖔᑕ
Name of Spouse / Common-law / ᐊᐃᑉᐸᖓᑕ ᐊᑎᖓ / ᐊᐃᑉᐸᕇᒃ ᑲᑎᑎᑕᐅᓯᒪᖏᑦᑑᖕ
Relationship / ᖃᓄᖅ ᐃᓚᒋᕕᐅᖕ
Have you or your household received funding from NHSP this fiscal year? / ᐃᕝᕕᑦ ᐃᓪᓗᒥᐅᖃᑏᓪᓘᓐᓃᑦ ᑮᓇᐅᔭᕐᑖᓚᐅᕐᓯᒪᕕᓰ ᓄᓇᕗᒥ ᐊᖑᓇᓱᑦᑎᓄᑦ ᐃᑲᔫᓯᐊᓂᑦ ᐊᕐᕌᒍᑦᑎᓂ?*
- Yes / ᐄ
- No / ᐋᒡᒐ
There is an annual funding limit of $1,000 per application and $2,000 per household per fiscal year. Your household includes your legal or common-law spouse. / ᐊᕐᕌᒍᑕᒫᑦ ᑮᓇᐅᔭᕐᑖᕈᓐᓇᕐᑐᑦ ᑭᓪᓕᖃᕐᑎᑕᐅᔪᑦ $1,000ᓄᑦ ᐊᑐᓂ ᑐᑦᓯᕋᕐᑐᑦ ᐊᒻᒪ $2,000 ᐊᑐᓂ ᐃᓪᓗᓖᑦ ᐊᕐᕌᒍᑕᒫᑦ. ᐃᓪᓗᒥᐅᖃᑎᑎᑦ ᐱᖃᓯᐅᔾᔨᓯᒪᔪᑦ ᒪᓕᒐᕐᑎᒍᑦ ᑲᑎᑎᑕᐅᓯᒪᑉᐸᑎᖕ ᐅᕝᕙᓘᓐᓃᑦ ᐊᐃᑉᐸᕇᓐᓂᕋᕐᑖᖕ ᑲᑎᑎᑕᐅᓯᒪᒐᑎᖕ.

Your parent, children or other family members or relatives living in the same house who are 16 years of age of older are considered separate households. / ᐊᖏᔪᖅᑳᑦ, ᕿᑐᕐᖓᑎᑦ ᐅᕝᕙᓘᓐᓃᑦ ᐊᓯᖏᑦ ᖃᑕᓐᖑᑎᑎᑦ ᐃᓚᑎᓪᓘᓐᓃᑦ ᐃᓪᓗᒥᐅᖃᑎᒋᔭᑎᑦ ᐅᑭᐅᓖᑦ 16ᓂᑦ ᐅᖓᑖᓄᓪᓘᓐᓃᑦ ᐃᓱᒪᒋᔭᐅᓂᐊᕐᑐᑦ ᐃᒻᒥᒃᑰᖓᓗᑎᖕ ᐃᓪᓗᖃᕆᐊᖏᑦ.
Confirm that you: / ᓇᓗᓇᐃᕐᓯᔪᓐᓇᕈᕕᑦ ᑕᐃᒫᖕ:*
- Need financial assistance to purchase small and/or safety equipment for harvesting / ᑮᓇᐅᔭᕐᑎᒍᑦ ᐃᑲᔪᕐᑕᐅᒋᐊᖃᕐᓂᕋᕐᓗᑎᑦ ᓂᐅᕕᕈᑎᑦᓴᒥᖕ ᒥᑭᔫᑎᓂᑦ ᐊᒻᒪ/ᐅᕝᕙᓘᓐᓃᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑎᓂᑦ ᓅᑦᑐᖅᓯᐅᑎᑖᕆᐊᖃᕈᕕᑦ ᐆᒪᔪᕋᓲᑎᓂᑦ
- Have suffered financial loss due to an accident or disaster / ᑮᓇᐅᔭᕐᑎᒍᑦ ᔭᒐᐃᓯᒪᒍᕕᑦ ᐱᕐᕈᓗᐊᕿᓂᑯᒧᑦ ᐅᕝᕙᓘᓐᓃᑦ ᓯᓚᒧᑦ ᖃᓄᐃᓕᑳᓪᓚᓐᓂᑯᒧᑦ

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Funding / ᑮᓇᐅᔭᑦ
All fields with * are required / ᑎᑎᖅᓯᒪᔪᓕᒫᑦ ᐅᓪᓗᕆᐊᕐᖑᐊᓕᖕᒥ * ᑕᑕᑎᖅᑕᐅᒋᐊᖃᖅᑐᑦ
How do you wish to receive the funds? / ᖃᓄᖅ ᑭᓇᐅᔭᐃᑦ ᐱᔪᒪᓂᐊᖅᑭᒋᑦ?*
Attach Void Cheque / ᓯᒃᑭ ᐊᑐᕈᓐᓃᖅᑎᓯᒪᓗᒍ*
Max. file size: 300 MB.
Where should we send your cheque? / ᓇᒧᑦ ᐊᐅᓪᓚᖅᑎᒃᑲᔭᖅᐸᕗᑦ?
Mail cheque to this address / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᑐᕌᕈᑖ*
Street Address / ᐃᒡᓗᕕᑦ ᑐᕌᕈᑖ City / ᓄᓇᖓ Province / ᓄᓇᓕᐅᑉ ᐊᕕᒃᑐᖅᓯᒪᓂᕆᔭᖓ Postal Code / ᑎᑎᖅᑲᓂᐊᕐᕕᒃᑯᑦ ᓇᓗᓇᐃᒃᑯᑕᖓ

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Thank you for submitting to the NHSP program. You will receive a confirmation email of your application. If your application is approved, the decision will be publicized through our website community posting and noticed to HTO.
ᖁᔭᓐᓇᒦᖕ ᑐᑦᓯᕋᓐᖑᐊᑕᕐᓯᓐᓇᕋᕕᑦ ᓄᓇᕗᒥ ᐊᖑᓇᓱᑦᑎᓄᑦ ᐃᑲᔫᓯᐊᑦᓴᓂᑦ. ᓇᓗᓇᐃᕐᓯᕕᐅᓛᖅᑯᑎᑦ ᐃᕐᖕᓃᓐᓈᕈᑎᒃᑯᑦ ᑎᑎᕋᕐᕕᐅᓗᑎᑦ ᑐᑦᓯᕌᑎᑦ ᒥᑦᓵᓄᑦ. ᑐᑦᓯᕋᐅᑏᑦ ᐊᖏᖅᑕᐅᓂᖅᐸᑦ, ᐃᓱᒪᓕᐅᕈᑎᒥᓃᑦ ᓴᖅᑭᑕᐅᓛᕐᒥᔪᑦ ᖃᕆᓴᐅᔭᒃᑯᑦ ᐅᓂᒃᑳᕐᕕᑎᓂ ᓄᓇᓕᓐᓄᑦ ᑐᕌᖓᕙᑦᑐᓂᑦ ᐊᒻᒪ ᖃᐅᔨᒃᑲᕐᑕᐅᓛᕆᓪᓗᑎᖕ ᓄᓇᓕᓐᓂ ᐊᖑᓇᓱᑦᑏᑦ ᑲᑐᔾᔨᖃᑎᒌᖏᑦ.
Declaration

I am applying for funding assistance under the Harvesting Equipment Program administered by Nunavut Harvesters Support Program (NHSP).

To the best of my knowledge, all of the statements or information in this application are true. I understand that any false or misleading information will result in my application being denied and may disqualify my organization or myself from receiving future funding assistance from NHSP or Qikiqtani Inuit Association (QIA).

I promise that any assistance received under this program will be used for the proposed harvesting equipment only.

I give permission to NHSP to collected and use my personal information related to this application and to make inquiries needed to evaluate this application. Upon receiving assistance, I will agree to supply any relevant receipts, records or other relevant information requested by NHSP.

My receipt of assistance will not make me an employee, contractor, or agent of NHSP or QIA.

By submitting this application, you agree to the above declaration.
ᓇᓗᓇᐃᕐᓯᒍᑦ ᐊᖏᕐᓂᕐᒧᑦ ᐊᑎᓕᐅᕐᕕᒃ

ᑐᒃᓯᕋᐅᑎᒐ ᑮᓇᐅᔭᑎᒍᑦ ᐃᑲᔪᖅᑕᐅᔾᔪᑎᒃᓴᓂᒃ ᐊᖑᓇᓲᑎᒃᓴᓄᑦ ᐱᖁᑎᓄᑦ ᐃᑲᔫᑎᒃᓴᓂᒃ ᐊᐅᓚᑕᐅᔪᒥᒃ ᓄᓇᕗᒻᒥ ᐊᖑᓇᓱᒃᑎᓄᑦ ᐃᑲᔫᑎᒃᓴᓕᕆᔨᒃᑯᓐᓂᒃ (NHSP).

ᖃᐅᔨᒪᓂᒃᑯᑦ, ᑎᑎᕋᖅᑕᐅᔪᓕᒫᑦ ᑐᓴᕈᑎᓕᐊᖑᔪᓕᒫᓪᓘᓐᓃᑦ ᑖᒃᑯᓇᓂ ᑐᒃᓯᕋᐅᑎᓂ ᓱᓕᔪᑦ. ᑐᑭᓯᔪᖓ ᓱᓕᓐᖏᑦᑐᓂᒃ ᐅᕝᕙᓘᓐᓃᑦ ᐱᔭᖅᑯᒻᒥ ᓱᓕᓐᖏᑦᑐᓂᒃ ᑐᓴᕈᑎᓕᐅᖅᑐᖅ ᑐᒃᓯᕋᐅᑎᖓ ᕿᐱᓗᒃᑕᐅᑦᓴᐅᑎᒋᓂᐊᖅᑐᖅ ᐊᒻᒪᓗ ᐊᔪᓕᖅᑎᑕᐅᓗᑎᒃ ᑲᑐᔾᔨᖃᑎᒌᓐᓃᕕᒃᑲ ᐅᕙᖓᓘᓐᓃᑦ ᓯᕗᓂᑦᑎᓐᓂ ᑮᓇᐅᔭᑎᒍᑦ ᐃᑲᔪᖅᑕᐅᓂᕐᒥᒃ NHSP−ᑯᓐᓂᒃ ᐊᒻᒪᓗ/ᐅᕝᕙᓘᓐᓃᑦ ᕿᑭᖅᑕᓂ ᐃᓄᐃᑦ ᑲᑐᔾᔨᖃᑎᒌᑦ.

ᓱᓕᓪᓗᖓ ᐃᑲᔪᖅᑕᐅᔾᔪᑎᓕᒫᒃᑲ ᑖᒃᑯᑎᒎᓇ ᐊᐅᓚᓂᐅᔪᒃᑯᑦ ᐊᑐᖅᑕᐅᓂᐊᕐᓂᖏᓐᓂᒃ ᑐᒃᓯᕋᐅᑕᐅᔪᒧᑦ ᐱᖁᑎᓄᑦ ᐊᖑᓇᓲᑎᒃᓴᐃᓇᕐᓄᑦ.

ᐅᕙᖓ, ᑕᑉᕙᓂ, NHSP−ᑯᑦ ᓄᐊᑦᓯᔪᓐᓇᖁᓪᓗᒋᑦ ᐊᑐᕐᓗᑎᓪᓗ ᐅᕙᓐᓅᖓᔪᓂᒃ ᑐᓴᐅᒪᔾᔪᑎᓂᒃ ᐊᒃᑐᐊᔪᓂᒃ ᑖᑦᓱᒧᖓ ᑐᒃᓯᕋᐅᑎᒧᑦ ᐊᒻᒪᓗ ᖃᐅᔨᒋᐊᕈᓐᓇᖁᓪᓗᒋᑦ ᖃᐅᔨᓴᕐᓗᑎᒃ ᑖᑦᓱᒧᖓ ᑐᒃᓯᕋᐅᑎᒧᑦ. ᐃᑲᔪᖅᑕᐅᔾᔪᑎᑖᓚᐅᖅᑎᓪᓗᖓ, ᐊᖏᕈᑎᖃᕐᐳᖓ ᑐᓂᓯᓂᐊᕐᓂᕐᒥᒃ ᓇᓕᖅᑲᓂᒃ, ᑎᑎᕋᕐᓯᒪᔪᓂᒃ ᐅᕝᕙᓘᓐᓃᑦ ᐊᓯᖏᓐᓂᒃ ᐊᒃᑐᐊᔪᓂᒃ ᑐᓴᐅᒪᔾᔪᑎᓂᒃ ᑐᒃᓯᕌᖑᑉᐸᑕ NHSP−ᑯᓐᓂᒃ.

ᐃᑲᔪᖅᑕᐅᔾᔪᑎᒐ ᐃᖅᑲᓇᐃᔭᖅᑎᕈᕈᑎᒋᔾᔮᖏᑦᑕᕋ, ᑳᓐᑐᓛᒃᑕᐅᓂᕐᒧᑦ, ᑭᒡᒐᖅᑐᐃᓂᕐᒧᓘᓐᓃᑦ NHSP−ᑯᓐᓂᒃ ᕿᑭᖅᑕᓂ ᐃᓄᐃᑦ ᑲᑐᔾᔨᖃᑎᒌᑦ ᓘᓐᓃᑦ.

ᑖᒃᑯᐊ ᑐᓂᓪᓗᒋᑦ ᑐᔅᓯᕋᐅᑎᑎᑦ, ᐊᖏᖅᑐᑎᑦ ᑖᒃᑯᓄᖓ ᖁᓛᓃᑦᑐᓄᑦ ᓇᓗᓇᐃᕈᑕᐅᔪᓄᑦ.

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Nunavut Harvest Support Program

Nunavut Harvester Support Program

Step 1 of 4

Personal Information / ᐃᕝᕕᑦ ᒥᔅᓵᓄᑦ ᑐᑭᓯᐅᒪᔾᔪᑎᔅᓴᑦ

Household Information / ᐃᓪᓗᒥᐅᖃᑎᒌᑦ ᖃᓄᐃᓕᖓᒻᒪᖔᑕ

Funding Request / ᑮᓇᐅᔭᓂᑦ ᑐᑦᓯᕋᐅᑦ

Small Equipment / ᒥᑭᔫᑏᑦ ᓅᑦᑐᖅᓯᐅᑏᑦ

Small Equipment Totals / ᒥᑭᔫᑏᑦ ᓅᑦᑐᖅᓯᐅᑏᑦ ᑲᑎᓪᓗᒋᑦ

Safety Equipment / ᓱᓇᒃᑯᑏᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑏᑦ

Safety Equipment Totals / ᓱᓇᒃᑯᑏᑦ ᐊᑦᑕᓇᕐᔭᐃᕈᑏᑦ ᑲᑎᓪᓗᒋᑦ

Disaster Relief / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ

Replacement Equipment

Replacement Equipment Totals / ᐱᕐᕈᓗᐊᕿᔪᓄᑦ ᑲᑎᓪᓗᒋᑦ

Repair Equipment

Repair Equipment Totals

Insurance Coverage Purchase

Funding / ᑮᓇᐅᔭᑦ