Privacy and Security
Completed Access to Information Requests
Proactive Disclosure
Sample form only: do not complete
This form is for reference purposes only. It is not to be completed in this format.
To complete this form and submit it to the CRTC, download the form.
Applicants should consult Campus and community radio policy, Broadcasting Regulatory Policy CRTC 2010-499, 22 July 2010 (Broadcasting Regulatory Policy 2010-499), and more specifically paragraphs 12 to 17 to take note of campus and community radio definitions and mandates.
File electronically via My CRTC Account by attaching the application to the cover page. My CRTC Account allows you to securely submit documents to the Commission with a user ID and password. Therefore, a signature is not required when using My CRTC Account. Applicants who file their application in this manner are not required to submit a hard copy of the application and its related documents.
Applicants who need further information relative to CRTC processes can contact a Commission specialist at 1-866-781-1911.
The following questionnaire is in HTML format and may be downloaded to the word processing software of your choice. This enables you to complete the downloaded questionnaire by inserting your response in bold letters immediately following the question. You may add lines to the tables if necessary but do not alter or delete any text from the questionnaire.
The application must be divided into sections as set out in the questionnaire and include the numbered questions followed by the corresponding response. Responses must be provided, at a minimum, in a size 10 font.
The following documents should be submitted as separate electronic documents using the naming convention specified below. The document number (Doc#) indicates the ascending order in which the documents should appear on the public file.
| Document | Electronic file name |
|---|---|
| The Covering Letter (if any) | Doc1 - Cover Letter dated _____________ |
| The Application Form | Doc2 - Form 110 - APP -"Application to Renew a Broadcasting Licence for a Campus or Community Radio Programming Undertaking" |
| Appendix 1A | Doc3 - Appendix 1A - Supplementary Brief |
| Appendix 2A | Doc4 - Appendix 2A - Amendments to constituting documents |
| Each confidential document | NOT WEB - Doc - Confidential - "brief description of the document" |
| Each abridged version of each confidential document | Doc - Abridged version - "same description of document for which confidentiality is requested" |
Type of station:
AM undertaking ( ) FM undertaking ( )
Campus ( ) Community ( )
Location of undertaking: __________________________ Call sign: ___________| Call sign | Location |
|---|---|
Name of legal entity who is authorized by the Commission to operate this undertaking:
Address:
City:
Province/Territory:
Postal Code:
Telephone:
Fax:
Email:
(if there is no appointed designated representative under question 1.2)
Name:
Title:
Telephone:
Email:
I, _________________________, the applicant, hereby designate __________________ as my designated representative for and on my behalf and in my name to sign, file and complete (if necessary) an application with the Canadian Radio-television and Telecommunications Commission and to sign and file a reply with respect thereto and I do hereby ratify, confirm and adopt as my own act, such application and all replies made thereto.
Date:
At: Example: city, province
Signature (a signature is not required when submitting electronically):
Address of designated representative:
Title:
Telephone:
Fax:
Email:
I, ___________________________________ ,solemnly declare that:
I am the designated representative of the applicant named in this application brief and as such have knowledge of all matters declared therein.
The statements made in this application or any document filed pursuant to any request for further information by the Commission are (will be) to the best of my knowledge and belief true in all respects.
The opinions and estimates given in this application or any document filed pursuant to any request for further information by the Commission are (will be) based on facts as known to me.
I have examined the provisions of the Broadcasting Act,the broadcasting regulations and policies relevant to this application.
And I have signed
Signature (a signature is not required when submitting electronically):
Date:
Witnessed by
Signature (a signature is not required when submitting electronically):
Name:
Date:
At:
Example: city, province
The Canadian Radio-television and Telecommunications Commission Rules of Practice and Procedure (the Rules of Procedure) allow an interested person to request that the Commission exercise a power under the Rules of Procedure or change the Rules of Procedure for a specific proceeding (sections 5 and 7). This is generally called a procedural request. You may consult Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and Guidelines on the CRTC Rules of Practice and Procedure, Broadcasting and Telecom Information Bulletin CRTC 2010-959, 23 December 2010, for more information.
Is the applicant requesting that the Commission make an exception to its Rules of Procedure in the treatment of this application?
Yes ( ) No ( )
If yes, please indicate which section of the Rules of Procedure you wish to vary and provide a detailed rationale as to why this request should be granted :
The Commission will return the application if it has not been duly completed. The onus will be on the applicant to submit a complete application that provides all of the relevant information, to identify all regulatory issues raised in the application and to provide supporting documentation.
Submit a website address or email address where an electronic copy of the application may be requested:
Website:
Example: www.mycompany.com
Email:
Example:
no-reply@no-reply.com
The undertaking is being operated in compliance with the provisions of the licence, the Broadcasting Act and all regulations and policies applicable to the CRTC.
Yes ( ) No ( )
If no, provide the full details of any non-compliance that occured during the licence term, including the reasons, any remedial action and, where applicable, the period of time expected before the undertaking is operating in compliance.
The licensee will adhere to all conditions of licences set out in Standard conditions of licence for campus and community radio stations, Broadcasting Regulatory Policy CRTC 2012-304, 22 May 2012 (Broadcasting Regulatory Policy 2012-304).
Yes ( ) No ( )
For each amendment proposed, provide the following information in a supplementary brief identified as Appendix 1:
a description of your current commitments as well as the status of those commitments;
a description of your proposed changes;
the reasons in support of the proposed changes in relation to your service overall, Broadcasting Regulatory Policy 2010-499, Broadcasting Regulatory Policy 2012-304, the broadcasting system and the Broadcasting Act; and
the implications/repercussions of maintaining the current terms, conditions and definitions.
If the supplementary brief exceeds 10 pages, include an executive summary.
In the case of changes to the technical installations, you must complete form 303, Amendment Application Form.
If you are proposing to continue the operation
of an ethnic SCMO service, provide the language of
the service and the ethnic group being served.
If no changes or amendments were done to the constituting documents (for example, Letters Patent, By-Laws, etc.) of the licensee since the last renewal, please sign the following attestation:
I hereby declare that no changes were done since the last renewal.
Signature of licensee or its appointed agent (not required if submitting electronically):
Complete the following table relating to the directors and officers, including the Chief Executive Officer, of the licensee. Please note that all sections must be completed.
| Name | Complete Home Address | Canadian (x) | Position Held |
Directors:
date and term of appointment Campus: also indicate the group represented (see 2.3) |
|---|---|---|---|---|
In Broadcasting Regulatory Policy 2010-499, the Commission stated that the mandate for campus radio distinguishes itself from the mandate for community radio in several ways, including the board of directors. The Commission expects that the board of directors for campus stations include campus representatives, including a balanced representation from:
In light of the above, please provide a detailed description of the means used to ensure that the structure and composition of the board of directors comply with the policy or the reasons for which the policy should not apply to your station.
All changes or amendments to the constituting documents (for example, Letters Patent, By-Laws, etc.) of the licensee.
The following section relates to the programming obligations set out in Broadcasting Regulatory Policy 2010-499.
For details on content categories and subcategories, applicants should refer to Revised content categories and subcategories for radio, Broadcasting Regulatory Policy 2010-819, 5 November 2010.
Licensees are reminded that, except where the Commission has otherwise provided in a condition of licence, they must also comply with the regulatory requirements set out in the Radio Regulations, 1986 (the Regulations), as amended from time to time.
For the purpose of answering the following section, applicants are reminded that in accordance with the Regulations, a "broadcast week" refers to the total number of hours devoted to broadcasting during the 126-hour period extending from 6 a.m. to midnight for seven consecutive days beginning on Sunday.
The licensee proposes to broadcast_____hours per broadcast week.
| Languages | Per broadcast week | ||
|---|---|---|---|
| Hours | Minutes | % of total programming | |
| Other official language (maximum) | |||
| Languages of Aboriginal Canadians (minimum) | |||
| Third-language programming (1)(minimum) | |||
| Local news | % |
|---|---|
| Regional news | % |
Note: The total number of hours of local programming (3.4(a)) and wrap-around programming (3.4(b)) must be equal to the total number of broadcast hours (3.1) per broadcast week.
Yes ( ) No ( )
If yes, specify the name(s) of the network(s), the number of hours per broadcast day (6 a.m. to midnight) and the type of programming to be broadcast per week.
| Name | Hours : Minutes | Type (3) |
|---|---|---|
Yes ( )
No ( )
If yes, specify the originating station (call letters and location):
Please indicate the minimum percentage of each subcategory to be broadcast. The total percentage can be less than, but no more than, 100%.
| Music Sub-category(4) | Description | Minimum % of Total Music |
|---|---|---|
| 21 | Pop, Rock and Dance | |
| 22 | Country and Country-Oriented | |
| 23 | Acoustic | |
| 24 | Easy Listening | |
| 31 | Concert | |
| 32 | Folk and Folk-Oriented | |
| 33 | World Beat and International | |
| 34 | Jazz and Blues | |
| 35 | Non-classic Religious | |
| 36 | Experimental Music |
Provide plans for the licence term with respect to the development of local talent in the fields of music and spoken word, such as projects to promote and feature music and spoken word creations by new Canadian artists, local artists and artists whose music is seldom heard on other stations.
The licensee operates in a market served by an ethnic radio station:
Yes ( ) No ( )
If yes, respond to question 3.10.
Complete the following table relating to the broadcast of ethnic and third-language programming.
Please note that a "broadcast week" refers to the total number of hours devoted to broadcasting during the 126-hour period extending from 6:00 a.m. to midnight, for seven consecutive days beginning on Sunday. Percentages should be based on the total number of hours of programming broadcast by the station in a broadcast week (that is, the total number of hours of programming by the station in a broadcast week may be less than or equal to 126 hours).
Please note that ethnic programming means programming provided in any language that is specifically directed to any culturally or racially distinct group other than one that is Aboriginal Canadian or from France or the British Isles. Ethnic programming may be in English, French, a third-language or a combination of languages. Third-language programming means programming in languages other than French, English or those of Aboriginal Canadians.
In determining the languages of ethnic programming, DO NOT consider music, advertising, station contests and community and emergency messages during a particular ethnic program. However, in calculating the actual duration of each program, those elements must be counted.
| Language in which ethnic programming is provided | Ethnic group to which it is directed |
Total duration of this programming per broadcast week
(hours:minutes) |
% of the total programming provided during each broadcast week that is devoted to this type of programming |
|---|---|---|---|
| % of the total programming provided during the broadcast week that is devoted to ethnic programming | |||
| % of the total programming provided during the broadcast week that is devoted to third-language programming | |||
Sections 30 to 34 of the Rules of Procedure set out a process by which parties to Commission proceedings may file information on the record of a public proceeding in confidence.
A party filing information can “designate” it as confidential at the time it is filed with the Commission (section 31) if it falls into one of the following categories:
At the time that the party files the information it designates as confidential, it must provide an abridged version of the document along with an explanation of how the information falls into a category of information listed in section 31. The party must provide a detailed rationale to explain why the disclosure of the information is not in the public interest (section 32(1)).
The confidential version of the document must be filed separately and must be marked “confidential” on each page. If the document is filed electronically, each file containing confidential information must include “confidential” in the file name.
The abridged version of the document and the reasons for the designation of information as confidential will be placed on the public record of the proceeding.
Please consult Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and Procedures for filing confidential information and requesting its disclosure in Commission proceedings, Broadcasting and Telecom Information Bulletin CRTC 2010-961, 23 December 2010, for the complete process for filing confidential information.
Are you requesting for some information to be designated as confidential?
Yes ( ) No ( )
If yes, you must provide a detailed rationale to explain why the disclosure of the information is not in the public interest:
| Appendix Number and Name | Appended
(Yes or No) |
E-filed
(Yes or No) |
|---|---|---|
| Section 1: General Information | ||
| 1A - Supplementary Brief | ||
| Section 2: Ownership | ||
| 2A - Amendments to constituting documents | ||
(1) Designates programs in languages other than English, French or those of Aboriginal Canadians. Applicants who broadcast ethnic programming must answer questions 3.9 and 3.10.
(2) Local programming includes programming that originates with the station or is produced separately and exclusively for the station. It does not include programming received from another station and rebroadcast simultaneously or at a later time, nor does it include network or syndicated programming that is five minutes or longer unless it is produced either by the station or in the local community by arrangement with the station. In their local programming, licensees must incorporate spoken word material of direct and particular relevance to the community served. This must include local news, weather, sports coverage as well as the promotion of local events and activities.
(3) Type of programming delivered by the network (for example, sports, talk, entertainment, etc.)
(4) See Revised content categories and subcategories for radio, Broadcasting Regulatory Policy CRTC 2010-819, 5 November 2010.
CRTC 110 (2012-09-28) - Community Radio - Renewal
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