Bursary Fund Report Form

This application will take about 1 hour to complete.

There is no way to save this form online and finish it later.

1. Agency Name

2. Charity Registration Number

3. Your First Name

Your Last Name

4. Your Email

5. The format of the professional development (conference, workshop, community of practice, retreat, course)

6. Name of Host City/Community

7. Host City/Community Postal Code

8. Start Date of the professional development

9. Final Date of the professional development

10. Number of registrations

11. Actual number of participants

12. Identify the number of participants from each professional level who attended this professional development.

ECE

ECE Assistants

School Age Child Care Providers

Licensed Family Child Care Providers

Registered LNRs

Responsible Adults (20 hours of training)

Other

13. Upload a spreadsheet of postal codes all participants here

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14. How many of the participants self-declared as First Nations, Métis or Inuit?

First Nation

Inuit

Métis

15. Describe if you used any strategies to engage First Nations, Métis or Inuit communities.

16. How many participants identified as Francophone

17. Provide the feedback from participants for the question below:

The ECE Professional Development Bursary Program subsidized **** (insert the costs that were subsidized, i.e. registration, transportation, accommodation etc. ) for this event. In what ways did these reduced rates make a difference for you in this learning experience?

Upload file here.

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or copy and paste participant’s feedback below

18. What evidence of capacity-building did you note or observe?

19. What successes were realized with this professional learning experience?

20. How did the bursary funding influence these successes?

21. How did this Bursary funding process impact you?

22. Event Expenses:

Please upload a file that shows how Bursary funds were used and the final balance. If Bursary funds were used to reduce registration fees, please describe the full cost of the registration fee and the amount that was supplemented by the Bursary funds.

Upload file here (.xlsx .docx or .pdf files only)

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23. What was the event registration fee for participants?

24. What would have been the registration fee for this event without support from the Bursary Fund Program?

25. What other comments or reflections would you like to provide?