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APATISIWIN FILE MAINTENANCE April 2022

AGENDA: • Overall File organization—reverse chronological order • Important Items: 1. Consent Forms 2. Photo ID/SIN 3. Intake + Resume • Action Plan • EI Verification • Conflict of Interest—if necessary • Sponsorship Approval 1. Contract/Amendments 2. Client Summaries 3. Request Package info: 4. 3rd Party Letter 5. Congrats letter 6. Employer or Trainer info • EI Verification training input • Financial information 1. Invoices 2. Receipts 3. Check Recs 4. Checks/EFT Payments • Staying on Track 1. Monitors 2. Attendance 3. Progress Reports 4. Case Notes • Income/Sponsorship Summaries—T4a • Mandatory File item check-list

REVERSE CHRONOLOGICAL ORDER • File should read like a book but in reverse order—front to back • Consents first—stapled to back of folder • Photo ID and SIN attached to Intake • Intake and action plan next stapled to intake form • A case note should accompany any and all correspondence, events, and or activities • Items will be added to file as you proceed with the case management/plan of care with the Direct Service user: example: EI Verification, resume, job ads, pre-employment items, etc. • Mandatory File items check list—stapled to inside front cover of file folder. Check mark/date as soon as the item is added to file

CONSENT FORMS 7.3 Personal Information Notice and Consent Form 1. Notice This Notice and Consent is intended to inform you how__________________________ (“the Friendship Centre/Delivery Site”) will collect, use, and disclose your personal information. In order to provide programs and services safely and efficiently, the Friendship Centre/Delivery Site requires certain pieces of personal information from you. The Federal Personal Information Protection & Electronic Documents Act and equivalent provincial legislation require that your consent be obtained prior to the collection and use of that information. Your personal information may be collected formally, in writing, and informally, by Friendship Centre/Delivery Site staff. This may include age, gender, marital status, income, education, disability, employment history, and any other information which the Friendship Centre/Delivery Site requires in order to deliver programs and services safely and efficiently. Your personal information may be stored in paper form and in electronic form. Additional personal information may be collected from time to time. Consent for the use of that personal information may be inferred where its uses are obvious and it has been voluntarily provided. Only necessary information about you will be collected. The Friendship Centre/Delivery Site will collect, use, and disclose information about you for the following purposes: a. To enable the Friendship Centre/Delivery Site to contact you; b. To ensure you are eligible for programs and services; c. To develop plans of care and practice case management of your file; d. To ensure you are physically and mentally able to participate in programs and services offered by the Friendship Centre/Delivery Site; e. To provide specific information into a data collection system, specific to the program(s) in which you participate; and f. For anonymous statistical analysis of programs and services. The storage, retention, and destruction of your personal information complies with the Friendship Centre/Delivery Site’s maintenance policy, applicable legislation and privacy

7.4 Release of Liability, Waiver of Claims & Indemnity Agreement Form I, _____________________________________________________ (“the Participant”), wish to participate in _____________________________________ (“the Program”), offered by ______________________________ (“the Friendship Centre/Delivery Site”). I have read and understand the rules and safety provisions established for the Program. I have had the opportunity to discuss with the Friendship Centre/Delivery Site any risks, dangers, or hazards to my person resulting from participation in the Program. I am aware that my participation in the Program is voluntary. I freely accept and fully assume all such risks, dangers and hazards, the possibility of delay or inconvenience, Program cancellation or change, the loss of personal property, injury and death. In consideration of the Friendship Centre/Delivery Site allowing my participation in the Program, I agree to the following: 1. Not to sue, release and discharge the Friendship Centre/Delivery Site, its officers, agents and employees, from all liability to me, my personal representatives, heirs, and next of kin, for all loss or damage and to waive any claim or demands on account of my injury or death, or damage to my property arising out of my participation in the Program; 2. That this Agreement shall not apply to any personal or property damage sustained by me arising from the negligent acts or omissions of the Friendship Centre/Delivery Site; 3. To indemnify and hold harmless the Friendship Centre/Delivery Site from any loss, liability, damage or costs that I may incur due to my acts or omissions during participation in the Program; 4. That I agree to comply with the rules and safety provisions established for the Program; 5. To certify that I am physically fit and able to safely engage in the Program; 6. That in the event of any accident or sudden illness, the Friendship Centre/Delivery Site has my permission to have performed on me whatever medical emergency treatment may be deemed necessary; and 7. That this Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or

7.6 UNIVERSAL CONSENT & RELEASE CLIENT DISCLOSURE FORM: FOR THE COLLECTION, USE AND DISCLOSURE OF PERSONAL HEALTH INFORMATION The undersigned (the “Participant”) and, if Participant is an unmarried minor, the Participant’s parent or legal guardian, for and in consideration of the granting of permission by _____North Bay__________(the “Friendship Centre”) for the Participant to take training. 1. Agrees not to sue and releases and discharges the Friendship Centre, its officers, agents and employees, from all liability to Participant, his personal representatives, heirs, and next of kin, for all loss or damage and waives any claim or demands an account of injury to or death of the Participant, or damage to the property of Participant, arising out of the participation of Participant in the above course and/or activity. This agreement, release, waiver and discharge, shall not apply to any personal or property damage sustained by Participant arising from the negligent acts or omissions of the Friendship Centre. 2. Agrees to indemnify and hold harmless the Friendship Centre from any loss, liability, damage or costs that may be incurred due to the acts or omissions of Participant during participation in the above program. 3. The undersigned certify that the Participant is physically fit and able to engage in the training. 4. In the event of any accident (or sudden illness), the Friendship Centre has my permission to have performed whatever medical emergency treatment may be deemed necessary to Participant. 5. It is further agreed that the undersigned have read, understand, and agree to comply with the rules and safety provisions established for said course and/or activity. 6. The Friendship Centre will collect, use, and disclose information about you for the following purposes: To enable us to contact you; o to establish and maintain communications and contact with you; o to provide necessary services to you in a variety of areas; office visits, home visits, assessments, accompany you on appointments, meetings, conferences, court appearances, hospitals, treatment centers, healing lodges and others as identified ; o to develop plans of care and practice appropriate case management of your file; to provide specific information into a data collection system specific to the program(s) which may include information on: age, sex, education, residency, number of children, Aboriginal status, adoption, residential

CLIENT RIGHTS STATEMENT We hope that your experience at the North Bay Indigenous Friendship Centre will be a rewarding one for you and/or your family. Our aim is to provide you with quality services and support. The North Bay Indigenous Friendship Centre is grounded in the fundamental value of respect. We acknowledge that to show respect entails the obligation to share and give of ourselves in the provision of services. In our work, we will demonstrate respect for children, youth, families, communities, staff, care providers, Elders and the traditions and culture. This respect is demonstrated through effective listening, clear communication, a nonjudgmental attitude and recognition of cultural diversity and the unique strengths of others. It is demonstrated by a shared commitment to safeguard the rights and dignity of those we serve. The North Bay Indigenous Friendship Centre is committed to ensuring anyone with a communication barrier has the proper support. Example of a barrier could be difficulties in sight; hearing; language other then English; literacy; etc. Please do not hesitate to tell your program worker if you require assistance. 1. Client Service We will operate from the position that the proper role of NBIFC service providers is to facilitate the ability of individuals and families to help themselves, while supporting the development of strong and healthy indigenous communities. NBIFC service providers will therefore not assume responsibility that properly belongs to the individual or family and which they are capable of assuming. We will regard the people we serve not as passive recipients of a service, but rather as participants who should share control over some dimensions of the services they receive. To the degree allowed by age and capacity, individuals will participate in decisions about goal setting, frequency of appointments, referral to other resources, participation of other parties

NBIFC Apatisiwin Program Employment & Training: Programs & Services I, , consent to the release of information in regards to Health, Education/Employment/Training with representatives of the North Bay Indigenous Friendship Centre, and with representatives of the following agencies with respect to my file with: Steven Guilbeault - Counsellor - NBIFC Apatisiwin Employment & Training With representatives of the following agencies: Canadore College, Service Canada, Information and Communication Technology Council, OFIFC(Apatisiwin). Information to be released will only include, information pertaining to: Inquiry regarding returning to school/employment/training, Employment Insurance, EI Verifications, Social Insurance Number, Address, Number, Training Plan, Date of Birth. Income, Marital Status, Telephone, sponsorship, transcripts, attendance, and progress reports. The information will only be released from the date of this consent, which is April 8, 2022 until March 31, 2023 This authorization is valid between these dates or until revoked in writing by me. It is understood that any exchange or information pertaining to my file will be held in strict confidence between all parties noted above. Dated at North Bay, April 8, 2022. ______________________________ Client Name: ________________________________ Client Signature _Steven Guilbeault _____________ Witness Name ________________________________ Witness Signature 980 Cassells Street North Bay, ON, P1B 4A8 : (705) 472-2811 : (705) 472-5251 : www.nbifc.org

INTAKE

Universal Consent Personal Information Notice and Consent has been signed?  Yes  No Release of Liability, Waiver of Claims and Indemnity Agreement has been signed?  Yes  No General Information Client ID: Retrieved from the IDB Date of Intake: MM/DD/YYYY First Name: Middle Name: Last Name: Date of Birth: MM/DD/YYYY Gender: □ Man □ Woman □ Two Spirit □ Transgender □ Non-binary □ None of the above, I identify as: ______________________________________ My pronouns are: □ He/him/his □ She/her/hers □ They/them/theirs □ Another pronoun: _________________________ S.I.N: Marital Status:  Married  Divorced  Widowed  Minor – 16 years and under  Single  Separated  Undisclosed  Common Law Other Are you a person who identifies with a disability?  Yes  No First Language: Second Language: Contact Information Address Type: Mailing Address  Permanent Address  Temporary  Homeless Shelter  Co-Op  Transient  Native Housing  Social Housing  Other _____________ Unit / Apt. #: Street Address: City: Province: Postal Code: Country: Phone Number: Email Address: Emergency Contact Name: Emergency Contact Phone Number: Client Details Client Type:  CRF  Active E.I.  E.I. Reach-back EI Claimant:  Active EI  Uninsured  EI Reach Back Number of Dependents: ______ Residency:  On-Reserve  Off-Reserve First Nation Affiliation: Band #: Identity:  First Nation: Status  First Nation: Non-Status  Métis  Inuit  Non-Indigenous  Undeclared Current Source of Income:  Employment Income  No Income  Canada Pension Plan  Social Assistance  Workers Compensation  Employment Insurance Status at Intake:  Employed (Full-Time)  Employed (Part-Time)  Unemployed  Student NOC Code: _________

ACTION PLAN

Apatisiwin Action Plan Client Details Client IDB ID#: Full Name: D.O.B: (DD/MM/YYYY) Phone Number: Action Plan Details Today’s Date: Childcare required to complete your intervention:  Yes  No If so, amount requested: $ Childcare funded by: Employment and Training Goals Short Term: Intermediate: Long Term: Target NOC: ________ Target Action Plan Result:  Employed  Self Employed  Return to School  Stay in School  Ready for Work  Improved Employability  Other Priority Objective (please choose one):  Pre-Employment and Preparation  Provide job search skills for clients all ages  Support clients in career exploration and career counseling  Prepare for GED/Diploma – Stay in School and grade 12 completion  Enhance clients’ literacy and numeracy skills before attending training  Enhance clients required level of work experience that many employers are seeking  Provide clients an opportunity to enter the labour market immediately after completing secondary or post secondary  Supportive programming and resources to attract clients to access education to employment continuum services  Support living costs and other costs to support clients who are enrolled in training or employment activities  Provide services and support to individuals who are actively pursuing self employment or entrepreneurship activities  Support community-based projects or partnership activities  Support client with language, life skills, cultural awareness, etc.  Increase client’s employability and readiness for work Client Based Activities (Interventions) Required to Achieve Goals:

√ Application Processing √ Employment Counselling √ Intake √ Action Plan Development  Apprenticeship  Summer Jobs  Community Building & Partnerships  On the Job Training  Employment Supports  Pre-Employment Training  Purchase of Training  Training Supports  Self Employment  Stay In School  Pre-Career Development Action Plan Outcome: Action Plan Result:  Employed  Self Employed  Returned to School  No longer in labour force  Ready for Work  Stay in School  Improved Employability  Unemployed but available for work  Unspecified-client could not be reached  No longer in labour force  Other Return to School/Stay in School Details: Highest Level of Education on Exit:  Secondary School  College  Other non-university  University  No formal education  Up-to Grade 7-8  Grade 9-10  Grade 11-12  Secondary Diploma or GED  Some post-secondary training  Apprenticeship or trades certificate or diploma  College, CEGEP, or other non- university certificate or diploma  University certificate or diploma  University – Bachelor’s Degree  University – Master’s Degree  University - Doctorate Status Closed in IDB: NOC Code at Close: Date Closed: (DD/MM/YYYY)  Closed  Open Exit Industry from Intervention:  Agriculture and Others  Construction  Wholesale Trade  Financial Real Estate  Health Care & Social  Education Services  Business Services  Other Notes:

Date of Request: 2022-04-12 Name of ISETP Holder: Apatisiwin-Ontario Fed of Indigenous Friendship Centres-OFIFC Sub- Agreement Holder (specify): North Bay Indian Friendship Centre 1 Client Name (Surname and First initial only) Guilbeault. S 2 Social Insurance Number (last 4 digits only) 1111 3 Type of Request EI Verification 4 Intervention Type Choose an item 5 Training ID 98-ASETS 6 ISETP Project RC (Required Field) 3250-OFIFC 7 Indicate the date the client was approved for training (date activated in system) 8 Course Start Week 9 Course End Week 10 Approved Breaks (e.g. Christmas, March Break) Break 1 (week to week) 11 Break 2 (week to week) 12 Break 3 (week to week) 13 Project Number 14 Institution Code 15 (if applicable) Was this client counselled to quit employment in order to attend training? Choose an item 16 (if applicable) Was this client given an Authorization To Quit (signed by ISETP) to submit to Service Canada? Choose an item 17 Indicate the date the Authorization To Quit was signed (mandatory) Click to enter date 18 Question or Action requested: EI Verification 19 Rationale: 20 ISETP contact name: Steven Guilbeault Apatisiwin Employment & Training North Bay Indigenous Friendship Center North Bay ON P1B 4A8 705-472-2811 ext. 202 21 Service Canada Response: 22 Service Canada contact name: EI Verification 

Education/Training Sponsorship Application and Checklist: Apatisiwin Employment and Training Program Name: Date: To qualify for NBIFC Apatisiwin Program sponsored training program, certain criteria need to be met. To assist you with the application process, we have prepared a checklist with detailed steps. Note that Applicants must first meet program eligibility to submit a request for sponsorship. Step 1: Book appointment with Employment Counsellor Step 2: Meet program eligibility and then complete an intake and sign all consent forms Step 3: Request a sponsorship application and check list. Step 4: Gather required information and request follow up appointment with Employment Counsellor Please see checklist and ensure that this info has been collected/completed before booking 2nd appointment: ❖ Signed consents/intake form ❖ SIN number and Photo ID (Status card, Drivers License, etc.) ❖ Updated resume ❖ Name of the training provider/institution with contact name, phone number, and email ❖ Letter of acceptance/proof of enrollment from trainer or school ❖ Outline for the program or course ❖ Start and end dates ❖ Number of training hours per week ❖ Total cost of training including tuition, student fees, taxes ❖ Book list with prices and bookstore contact info ❖ E.I. Verification Form—to be completed by Employment Counsellor ❖ Letter of Request—prepare a brief letter that outlines your goals and why you are seeking financial assistance ❖ If possible, provide letters of support or reference. ❖ Please provide labour market research that pertains to your training/career goal ❖ Please provide a notification Letter from First Nations Band Office indicating that “No Funding” is available Important Information for Applicants: ❖ All sponsorship requests must be returned to the NBIFC Employment Office within 3 weeks of completing intake/registering for program. It is also advised that applications be submitted well in advance of course start date; we prefer 6 weeks in advance. ❖ Requests for sponsorship will be reviewed by the NBIFC Selection Committee and approval is dependant on several factors including budget and participant program eligibility. ❖ Are you planning to attend, or have been attending a school in a different city/location? This may affect funding eligibility. ❖ NOTE that the Apatisiwin Program has a maximum allowable funding amount per client Participant/Student Info: Client Name: Street Address: Town/City: Postal Code: Date of Birth: SIN #: Phone #: Email:

Participant Identifies as: First Nation Indigenous Metis Inuit Status Non-Status First Nation Affiliation: Are you a new Participant to the Apatisiwin program? Yes No If you are an existing Participant, please provide date when you last participated: Month:______ Year:______ Will you be employed during your course? Yes No Full-time Part-time Are you currently receiving EI benefits? Yes No Have you received EI benefits in the last 5 years? Yes No Have you applied for other funding opportunities? Yes No If yes, please provide more information: ______________________________________________________________ Have you contacted your First Nation Office regarding education sponsorship? Yes No School or Trainer Information: Street Address: Town/City: Postal code: Student Sponsorship Representative or trainer contact information: Name: ________________________________________ Email: ________________________________________ Phone: ________________________________________ Other information: Course Name: __________________________________ Course Code: __________________________________ Campus Location: ________________________________

CASE NOTES/PROGRESS REPORT: April 16, 2022: • Participant on time for appointment • Client provided sponsorship required items. • Will submit to selection committee for review • Client seeking tuition, books, and living allowance for 1st year of Indigenous Wellness and addiction prevention program • See supporting documentation attached • Will submit request package to Selection Committee for review.

Request Package Items: Original Contract X FILE No.: 12345 Amendment  # ___________ ARTICLES OF AGREEMENT Employment Benefits / Support Measures Purchase Of Training These Articles of Agreement are made as of April 11, 2022 BETWEEN APATISIWIN SITE (address) _________________________ AND EMPLOYER/TRAINER/CLIENT (herein referred to as the “RECIPIENT”). (address) AND CLIENT (list client only if between three parties i.e. Apatisiwin Site and Client plus Employer or Trainer) (Address) ___________________________ ___________________________ WHEREAS the RECIPIENT proposes to carry out the project described in Schedule A hereto and has applied to APATISIWIN SITE for financial assistance towards the costs of the program.

Schedule A – Additional Costs and Information Additional responsibilities of the recipient (employer) are as follows: • Progress report and monitor report to be completed before reimbursement cheques can be released. • Proper financial records of the business and for the participant are to be kept on file (securely). This includes EI deductions for the trainee (ie: payroll journal, ledger entry, time sheets, receipts, etc.). • Records to clearly indicate that the participant is being paid on a weekly or bi-weekly basis (ie: cancelled cheques, receipts, payroll journal, payment schedules, etc.). • To provide the agreed upon training to the participant which includes a report on skills learned, any new duties, or added responsibilities etc. • To contact Apatisiwin Employment/Youth Employment Counsellor to advise of any chances and/or concerns so that they may be resolved immediate (ie: participant quits, pay disputes, additional training, etc.). • In most cases, allow up to 15 working days for cheque to be released. • Failure to comply with the items listed may result in the Apatisiwin site cancelling the contract. The responsibilities of the Apatisiwin site counsellors are as follows: • All participants are to complete an Apatisiwin client intake and consent form. • Final reports (monitors) must be completed and submitted to Apatisiwin site prior to release of final payment. • To ensure that all claims are processed as outlined earlier on the employer’s responsibilities. • To make any chances to the contract and/or suggestions to improve contract. • To monitor the contract by visiting the employer, trainer, and participant at least twice to discuss the progress. of the training and to ensure that all responsibilities are being met.

Schedule D – Program and Services Information RECIPIENT INFORMATION (Employer/Trainer/Coordinator/Group) Name: (Employer/Trainer) Caandore College City: North Bay Prov: ON Postal Code: P1B 4A8 Contact Person: JAYE Phone No.: 705 123-4567 FAX No.: ( ) E Mail: Student sponsors@candorecollege.ca PARTICIPANT INFORMATION NAME: Jabba DATE OF BIRTH: Feb 10, 1980 Gender: X Male Female Unspecified Mailing Address: Tantooine TELEPHONE NO.: 489 456 7890 E Mail: The hut@gmail.com PROGRAM ELEMENTS- Summary of Objectives/Activities/Expected Results List Priority/Objectives Addressed by Intervention(s): INTERVENTION TITLE CHECK APPROPRIATE INTERVENTION(s) PLEASE CIRCLE FUND TYPE Apprenticeship Skills Training EI CRF Community Building and Partnerships EI CRF Employment Supports EI CRF On-The-Job Training EI CRF Pre-Employment Training EI CRF Purchase of Training X EI CRF X Self-Employment Training EI CRF Training Supports EI CRF Stay In School Program EI CRF Summer Jobs EI CRF Pre-Career Development EI CRF Identify Activities of Intervention: Expected Results of Intervention: PROGRAM & SERVICES INFORMATION Employment/youth employment Counsellor : Steven Guilbeault File Number: 123456 Intervention: Purchase of Training Budget: CRF APATISIWIN SITE : NBIFC NOC Code (if applicable): 3212 Responsible ISET Holder : OFIFC Occupational Title (if applicable): Social worker Training Location: (City) North Bay

Schedule D – Program and Services Information RECIPIENT INFORMATION (Employer/Trainer/Coordinator/Group) Name: (Employer/Trainer) Caandore College City: North Bay Prov: ON Postal Code: P1B 4A8 Contact Person: JAYE Phone No.: 705 123-4567 FAX No.: ( ) E Mail: Student sponsors@candorecollege.ca PARTICIPANT INFORMATION NAME: Jabba DATE OF BIRTH: Feb 10, 1980 Gender: X Male Female Unspecified Mailing Address: Tantooine TELEPHONE NO.: 489 456 7890 E Mail: The hut@gmail.com PROGRAM ELEMENTS- Summary of Objectives/Activities/Expected Results List Priority/Objectives Addressed by Intervention(s): INTERVENTION TITLE CHECK APPROPRIATE INTERVENTION(s) PLEASE CIRCLE FUND TYPE Apprenticeship Skills Training EI CRF Community Building and Partnerships EI CRF Employment Supports EI CRF On-The-Job Training EI CRF Pre-Employment Training EI CRF Purchase of Training X EI CRF X Self-Employment Training EI CRF Training Supports EI CRF Stay In School Program EI CRF Summer Jobs EI CRF Pre-Career Development EI CRF Identify Activities of Intervention: Expected Results of Intervention: DELIVERY INFORMATION “DURATION OF ACTIVITY” Start Date: September 1, 2022 # of Participants (for group interventions): 1 End Date: March 31, 2022 Selection Method (who approved the intervention): Personal Interview AUTHORIZATIONS / INITIALS OF SIGNATORIES TO THE AGREEMENT Recommended By Employment/Youth Employment Counsellor: Date: Client (if between three parties): Date: Employer, Training Institute, Client: Date: Approved By Executive Director: Date:

Schedule B – Payment Schedule Intervention Expense Date (Starting-Ending Dates) = $ TOTAL Purchase of Training Tuition September 7-Dec 17, 2022 $1704 Purchase of Training Tuition Jan1-March 31, 2023 $1801.88 Training Supports School Supplies September 1, 2022 to March 31, 2022 $1000 Training Supports Living Allowance September 1, 2022 to March 31, 2022 $5200=$40 per day x 5 days/per week+$200 per week x 26 weeks Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. (Please attach Schedule E to client and APATISIWIN SITE copies of contract for any Allowances if applicable) TOTAL CONTRIBUTION (INCLUDING AMOUNTS IN SCHEDULE E IF APPLICABLE) 9705.88

SCHEDULE D: APATISWIN CLIENT INTERVENTION CONTRACTUAL AGREEMENT ADDITION APATISIWIN TRAINING/LIVING ALLOWANCE PAYMENT SCHEDULE UAEWSP CONTRIBUTION PERIOD # DAYS AMOUNT/DAY TOTAL Sept 7-17, 2022 9 40.00 360.00 Sept 20-Oct 1, 2022 10 40.00 400.00 Oct 4-15, 2022 (one day off for thanksgiving) 9 40.00 360.00 Oct 18-29, 2022 (reading week off for 5 days) 5 40.00 200.00 Nov 1-12, 2022 10 40.00 400.00 Nov 15-26, 2022 10 40.00 400.00 Nov 29-Dec 17 2022, 15 40.00 600.00 Dec 18, 2022-Jan 2-2023 off xmas break - - - Jan 3-14, 2023 10 40.00 400.00 Jan 17-28, 2023 10 40.00 400.00 Jan 31-Feb 11, 2023 10 40.00 400.00 feb 14-25, 2023 (closed family day) 9 40.00 360.00 Feb 28-March 11, 2023 (5 days closed for reading week) 5 40.00 200.00 March 14-31, 2023 14 40.00 560.00 TOTAL BEFORE ATTENDANCE DEDUCTION 126 5,040.00

NBIFC APATISIWIN EMPLOYMENT & TRAINING UNIT CLIENT REQUEST – EXECUTIVE SUMMARY – CRF- PARTICIPANT Jabba DATE April 16, 2022 S.I.N. 123 456 2345 D.O.B.mm/dy/yyyy 03/04/1970 ADDRESS 123 street FIRST NATION AFFILIATION Attawapiskat PROGRAM REQUESTED Purchase of training PLACEMENT LOCATION Canadore North Bay ON START DATE September 7, 2022 END DATE March 31, 2023 PAST PROGRAM PARTICIPANT No Summary Participant has registered for the IWAP program Tuition $ Books $ ALLOWANCES ACCOMMODATIONS Admin fee TRANSPORTATION OTHER-MERC AMOUNT REQUESTED 2019-20 TOTAL ASSISTANCE REQUESTED $

APATISIWN PROGRAM DIRECT SERVICE USER SUMMARY CLIENT NAME: CLIENT ID NUMBER: PAST PARTICIPANT: FUNDING STREAM: BACKGROUND: • 25-year- CURRENT INTEREST: • Has requested financial support to complete • RECCOMNDATIONS: • SPONSORSHIP DETAILS: Intervention Details: • Tuition/Fees: $ • Books/Supplies: Total Funding Committed=$ Start Date: End Date: 980 Cassells Street North Bay, ON, P1B 4A8 : (705) 472-2811 : (705) 472-5251 : www.nbifc.org

NOTICE OF SPONSORSHIP Aug 17, 2022 Client Name 123 1st street North Bay Ontario P1A 1K2 Re: Sponsorship Approval Dear client The North Bay Indigenous Friendship Centre’s Apatisiwin Program has approved your request for sponsorship for the 1st year of the ___________program—Canadore College. We have approved the following: First semester tuition: $1800 Second Semester tuition: 1807 Books: not to exceed $1000. Living Allowance: $5040 ($40 per day x 121 days)—to paid out every 2 weeks—NOTE—you must provide attendance records before living allowance will be released. To remain in good standing, we require monthly progress reports and transcripts must be submitted at the end of each semester. Attendance is also very important and you are required to attend all scheduled classes, workshops, labs, and lectures. Missed classes could result in suspended or canceled living allowance and tuition sponsorship. Should you have any concerns or issues that develop while you are in class, please contact me as soon as possible and I will assist. Should you have any questions or concerns, feel free to contact me. Sincerely, Steven Guilbeault, Employment Counsellor ______________________________ Client Name: ________________________________ Client Signature _ _____________ Witness Name ________________________________ Witness Signature NORTH BAY INDIGENOUS FRIENDSHIP CENTRE 980 Cassells Street North Bay, ON, P1B 4A8 : (705) 472-2811 : (705) 472-5251 : www.nbifc.org

EMPLOYER/TRAINING INFO 1. Indigenous Wellness and Addictions Prevention 2. 2 Years – Ontario College Diploma HOW TO APPLY BOOK A TOUR CONTACT • Code: 010212 • Type: Full-Time • Go To Home Page • Programs/Courses • Indigenous Wellness And Addictions Prevention 3. Experience program-led culture camps 4. Overview Upcoming Intake: Fall 2022, College Drive – North Bay Gain the skills and knowledge you need for employment in a variety of addiction settings through practical, hands-on learning. The curriculum is based on the holistic teachings of the Medicine Wheel, with a focus on the root causes of addiction within Indigenous communities. You will learn both cultural and mainstream approaches to addictions counselling. Training ranges from pharmacology to traditional methods including Sacred Circles, Teaching/Learning Circles, and the use of the four sacred medicines – tobacco, cedar, sage and sweet grass. There is a placement component in this program.

EI VERIFICATION TRAINING INPUT 2022-04-12 Name of ISETP Holder: Apatisiwin-Ontario Fed of Indigenous Friendship Centres-OFIFC Sub- Agreement Holder (specify): North Bay Indian Friendship Centre 1 Client Name (Surname and First initial only) Guilbeault. S 2 Social Insurance Number (last 4 digits only) 1111 3 Type of Request Training Input 4 Intervention Type Choose an item 5 Training ID 98-ASETS 6 ISETP Project RC (Required Field) 3250-OFIFC 7 Indicate the date the client was approved for training (date activated in system) April 11, 2022 8 Course Start Week June 1, 2022 9 Course End Week Dec 31, 2022 10 Approved Breaks (e.g. Christmas, March Break) Break 1 (week to week) STAT HOLIDAYS Study week July 7-14, 2022 11 Break 2 (week to week) Study week October 7-14, 2022 12 Break 3 (week to week) N/A 13 Project Number 14 Institution Code 15 (if applicable) Was this client counselled to quit employment in order to attend training? Choose an item 16 (if applicable) Was this client given an Authorization To Quit (signed by ISETP) to submit to Service Canada? Choose an item 17 Indicate the date the Authorization To Quit was signed (mandatory) Click to enter date 18 Question or Action requested: EI Verification 19 Rationale: Client has been approved for sponsorship to participate in post secondary program—NBIFC apatisiwin to pay for tuition, books, and partial living expenses 20 ISETP contact name: Steven Guilbeault Apatisiwin Employment & Training North Bay Indigenous Friendship Center North Bay ON P1B 4A8 705-472-2811 ext. 202 21 Service Canada Response: 22 Service Canada contact name:

980 Cassells Street, North bay Ontario P1B 4A8 THIRD-PARTY SPONSORSHIP CONFIRMATION APATISIWIN EMPLOYMENT AND TRAINING 705 427 2811 ext. 202 apatisiwin@nbifc.org THIRD-PARTY SPONSORSHIP CONFIRMATION Date: ______________ Dear __________________, This sponsorship letter is for __________________ (add student name) and is a confirmation that the Apatisiwin Employment and Training Program will be paying for them to attend __________________ (add institution name) to take the ___________________ (add course or program info). For prompt payment of tuition/courses, it is required that all invoices be sent to: ______________________ (add email address). Please include a detailed summary of charges as well as the related Apatisiwin contract # indicated below. As discussed, all tuition/course fee invoice are due to Apatisiwin by: __________________________ (add date) so that payment can be issued and meet program reporting requirements. If the student withdraws and their tuition/course fees are eligible for reimbursement, please issue the refund to the paying (Apatisiwin program Friendship Centre). Please note, all students are required to sign an authorized consent to request and release and exchange information form with Apatisiwin. This allows Apatisiwin to contact training institutions to verify attendance of sponsored students. This is part of the student’s contractual obligations with Apatisiwin as to ensure they are still eligible to continue receiving funding for their studies. Please do not hesitate to call if you have any questions at (phone # or email address). Thank you. Apatisiwin Contract Number: _______________________ A. Trainer/Institution Information Name of Institution: Address: Contact Name: Title and Department: Phone #: Fax #: Email Address: Phone #: B: Sponsored Student Details C: Duration of Sponsorship & Program Information Student Name: Start Date: (MM/DD/YYYY): End Date: (MM/DD/YYYY) Date of Birth: (MM/DD/YYYY): ☐FT Studies ☐PT Studies ☐Winter ☐Fall ☐Summer ☐Spring Student ID: Program/Course Name(s): D: Student Accommodation Information: Student Accommodations Required ☐Yes ☐No Accommodation(s): E. Limitation of Coverage Sponsorship Covers: (ie: mandatory tuition, course fees, books, etc) Sponsorship does not cover: (ie: non-mandatory fees, etc.) Apatisiwin Employment/Youth Employment Counsellor: __________________ ____________________ Name Signature

FINANCIAL INFO

APATISIWIN 2022-2023 Check Rec
Date: April 11, 2022
From:Canadore CollegeAddress:123 the Street North Bay, Ontario

Description:1stsemester Tuition fees forStudent__________Invoice NumberInvoice dateClient #Student #Budget: CRfEFT payment

Signed:______________________________________________________________________





















PO #679692
DepartmentCodeAmount5141CRF Exp.17045145EI Exp.
5150Youth Exp.
5116Travel Exp.
5112Resource Exp.
5120Marketing Exp
5125Capacity Exp
5160ProfessionalDev. 
HST 
TOTAL:$1704

• Staple check rec copy and case note to invoice and make a copy of the check when possible • Use pink or red paper to highlight payments/check recs

STAYING ON TRACK MONITORS: • A mid and final monitor should be in the file • Other monitors could include transcripts, updates, check-ins. Etc.

Participant MID Monitor Participant Name: Employer/Trainer Name: NORCAT Employment Counsellor/Community Career Developer Name: Steven Guilbeault Contract Number:1234 Intervention Start Date: (MM/DD/YYY) Intervention End Date: (MM/DD/YYY) Monitor Date: (MM/DD/YYY) Monitor 1. Do you feel your training program is assisting you with achieving your desired career goal? If yes, how? If no, why? 2. Do you require any additional training? If yes, please specify. 3. Have you been actively seeking employment while completing your training program? If yes, what contacts have you made? If no, why not? 4. Do you have a job offer upon completion of your program? If yes, who is the employer? 5. Do you feel the program that you are participating in can be improved? If yes, how? 6. Would you recommend this training program to someone else? If yes, why? If no, why not? Signatures Participant Signature Date Employer/Trainer Signature Date

ATTENDANCE:•  NBIFC requires all students to submit attendance— •  Screen shot •  Created forms. •  OFIFC provided sample

 

Note that a case note should be attached to attendance submissions with date. 

Progress Reports:

CASE NOTES:
•  Word Document •  Brief account of what transpired •  Detailed but short--Only facts •  Document all correspondence, activities, events—including emails, texts, interviews, progress report, etc. Print emails and staple to case note page•  It’s a best practice to do a case note at the end of every appointment so the details are still fresh  •  Cut and paste from data base to word 



































INCOME SUMMARY

7.17 Apatisiwin  

SUMMARY OF APATISIWIN SPONSORSHIP 2021
SIN:123 456 789Name:Her NameAddress:94 Killbey LaneCallander, Ontario P0H 1H0
Contract Identifier(File Number):X111111Type of Intervention(EI or CRF):Purchase of TrainingCRF Contract Start Date(mm/dd/yyyy):September 7, 2021Contract End Date(mm/dd/yyyy):March 31, 2022
Time Period: January 1, 2021– December 31, 2021 (2021 Tax Year)INTERVENTIONSAMOUNT PAIDTuition: Semester 1 September-December2021$3310.10Books1304.93Living Allowance$5000Road test fee
Shuttle Service
MTO, Drive Test
Safety equipment/PPE




Total benefits paid:
T4a “other income” total funding/livingallowance client received directly$5000

2021 TOTAL FUNDING:$9615.03TOTAL INCOME TAX DEDUCTED:0.00_______________________________     _________________________________  
 Employment Counsellor’s Signature     Executive Director’s 

SUMMARY

File in reverse chronological orderAdd a case note for every activity, event, interview, intervention, correspondenceUse pink paper for financial info--check rec will stand out in the fileEnter info into the Mandatory File items checklist promptly