AFSC 4-H Grassroots Fund Application

  • I am applying on behalf of a registered 4-H Alberta Club
  • Only 4-H clubs in good standing with 4-H Alberta are eligible to apply for the 2022-2023 Grassroots Fund.
  • General Information
    Please provide contact details for the individual who will be the primary point of contact for all information about this request for funding.
  • Club Information
  • At AFSC, we are concentrating our 4-H Alberta Grassroots Funding efforts to align with the following focus areas: agriculture; education, outreach & training; and community well-being.

    Agriculture/Agri-Food: supporting the business of, or the advancement of the agriculture, agribusiness and agri-food industry, or the next generation of agriculture.

    Education, Outreach & Training: supporting initiatives and services that contribute to education, awareness and increased knowledge related to agriculture, agriculture financial literacy and agriculture risk management in order to help maintain stable high quality food development. Where members, leaders and community members gather and learn and may also include speaking engagements.

    Community Well-Being: initiatives that build community capacity, and/or contribute to healthy vibrant communities.
  • Project Details
  • How many participants will be involved in this project/event/ initiative?
  • Subject to current health protocols and mandates.
  • :
  • Are there any additional volunteer, speaking or representation opportunities AFSC should be aware of?
  • By submitting this application I confirm that I have the authority to submit this request and agree to the conditions described below.
  • I hereby certify that the information contained in this fund application is accurate.
  • I undertake to inform AFSC of any changes in the project/organization’s circumstance that would affect this application.
  • I will ensure compliance of all fund requirements. All funds received will be used in completing the proposed project.
  • I consent to AFSC sharing my name, application and contact information with 4-H Alberta for the purpose of selecting recipients for the AFSC 4-H Alberta Grassroots Fund.
  • I also agree, that should I be selected, 4-H Alberta and AFSC may use my (club/district/region's) name and / or my (club/district/region's) photograph in a various media channels to publicize and promote the AFSC 4-H Alberta Grassroots Fund, to which I submit an application.
  • This field is for validation purposes and should be left unchanged.

Freedom of Information and Protection of Privacy  Act

The information on this form, and any information you provide to us in the future related to this form, is collected under the authority of the Agriculture Financial Services Act (Alberta) and the Freedom of Information and Protection of Privacy Act (Alberta) (the “FOIP Act”).  The collected information, whether personal information or business information, will be used: (i) to evaluate your eligibility for the program to which this form relates; (ii) for the administration of the program; and/ or (iii) for the administration of any other AFSC program or benefit in which you participate.  Your personal information is subject to the provisions of the FOIP Act.

By submitting this form, you are providing your consent to AFSC disclosing and sharing the information contained on this form, whether personal information or business information, or any other information that will be provided in the future by you or your authorized representative, to the following third parties: B.C. Ministry of Agriculture, Alberta Ministry of Agriculture and Forestry, Saskatchewan Ministry of Agriculture, Saskatchewan Crop Insurance Corporation, Manitoba Ministry of Agriculture and Resource Development, Manitoba Agriculture Services Corporation, Agriculture and Agri-Food Canada, Canada Revenue Agency and Statistics Canada.  You consent that such disclosed and shared personal information and business information may be used in the following ways: (i) for the administration of all current and future AFSC, federal and provincial programs related to agriculture, AFSC lending programs and AFSC insurance programs; (ii) for AFSC, federal and provincial policy and program development; (iii) for AFSC, federal and provincial policy and program evaluation; (iv) for AFSC, federal and provincial program compliance; (v) for research development; and (vi) for statistical purposes.

If you have any questions about this form and the collection and use of your information, please contact AFSC at 5718 – 56 Avenue, Lacombe AB   T4L 1B1, 1.877.899.2372.