Required fields are marked with asterisks (*)

Community Improvement Plan Eligibility Screening Form

First name

Last name

Company name

Phone

Address

Town/City

Postal code

Address of property to be renovated

Are you the owner of the property or a tenant?

Owner

Tenant

Project details

Please include a description of the proposed program, how this relates to the current business (if applicable), and estimated expenses.

Project description

Estimated project value

Please provide an approximate start date for your project

Please provide an approximate end date for your project

Please note: Do not start project before filling out this form and contacting us, as it may eliminate you from receiving the grant

Notice of Collection

Personal Information contained on this form is collected under the authority of the Municipal Act, 2001, as amended and will be used for the purpose of processing this application/request. Questions about this collection may be directed to the Economic Development and Tourism Division at 905-318-5932 or opportunity@haldimandcounty.on.ca.