Application to Obtain a Broadcasting Licence to Operate a Community-based Television Programming Undertaking (including community-based low-power television undertaking and community-based digital service) - Form 116

General information

Applicants should consult the Commission's Policy framework for community-based media in Public Notice CRTC 2002-61 dated 10 October 2002.
1.	Filing
	File electronically via Access Key by attaching the application to the Cover page. Access Key allows secure transmissions to the Commission and also authenticates your identity. Therefore, a signature is not required when using Access Key. 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 cannot send their application electronically with the Access Key service or who need further information relative to the CRTC processes can contact the Commission at 1-877-249-CRTC (2782).
2.	Instructions
	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.
	Naming convention for the electronic documents
	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.
	The Covering Letter (if any) - Doc1 - Cover Letter dated ____ The Application Form - Doc2 - Form 116 Appendix 1A - Doc3 - Appendix 1A - Supplementary Brief Appendix 2A - Doc4 - Appendix 2A - Constituting Documents (or drafts) Appendix 2B - Doc5 - Appendix 2B - Statement on Control of Applicant Appendix 2C - Doc6 - Appendix 2C - Delegation of Responsibility by Contract Appendix 2D - Doc7 - Appendix 2D - Documentation Supporting Availability of each Source of Financing Appendix 6A - Doc8 - Appendix 6A - Maps - Proposed Service Area (if different from cable operator(s)) Appendix 6B - Doc9 - Appendix 6B - Maps - Proposed Coverage Contours Appendix 6C - Doc10 - Appendix 6C - Documentation Supporting the Availability of the Proposed Transmitter Site(s) Appendix 7A - Doc11 - Appendix 7A - Block Program Schedule Each confidential document - NOT WEB - Doc# - CONFDOC - "brief description of the document" Each abridged version of each confidential document - Doc# - ABRIDGED VERSION - "same description of document for which confidentiality is requested"
	The Commission may return the application if it has not been duly completed or if the required technical documentation has not been filed with Industry Canada. The onus will be on the applicant to submit a clear application that provides all of the relevant information, identifies all regulatory issues raised in the application and provides supporting documentation.

Canadian Radio-television and Telecommunications Commission

Form 116 - Application to Obtain a Broadcasting Licence to Operate a Community-based Television Programming Undertaking
(including community-based low-power television undertaking and community-based digital service)

1. General information

TYPE OF UNDERTAKING:	Community-based low-power Television Undertaking* ( )
	Community-based full-power Television Undertaking ( )
	Community-based digital service ( )

*Low-power TV is a station operating with a transmitter power of 50 watts or less on the VHF band, or 500 watts or less on the UHF band. The Grade B contour cannot exceed 12 kilometres in any direction from the antenna site.
LOCATION OF UNDERTAKING: ________________________
1.1	IDENTIFICATION OF PROPOSED LICENSEE (hereinafter the applicant)
	Individual ( )	Company to be incorporated ( )
	Company ( )	Other ( ) Specify: ____________________

	NAME: ADDRESS: Facsimile: Email: CONTACT PERSON REPRESENTING THE APPLICANT (if there is no designated representative under question 1.2) NAME: TITLE: TELEPHONE:
1.2	Appointment of designated representative I, _________________________, the applicant, hereby appoint _____________________ 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: Signature (not required if submitting electronically): ADDRESS OF designated representative: TITLE: TELEPHONE: Facsimile: Email:
1.3	DECLARATION OF THE APPLICANT or its designated representative
	I, ___________________________________ SOLEMNLY DECLARE THAT:
	a)	I am the designated representative of the applicant named in this Application Brief and as such have knowledge of all matters declared therein.
	b)	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.
	c)	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.
	d)	I have examined the provisions of the Broadcasting Act and the broadcasting regulations relevant to this application.
	AND I HAVE SIGNED Signature (not required if submitting electronically): Date: WITNESSED BY Signature (not required if submitting electronically): Name (Printed): Date: At:
1.4	Location(s) where the application may be examined Set out the applicantÃ¢â‚¬â„¢s website address or, if the application is not posted on their website, the email address where an electronic copy of the application may be requested: Website: Example: www.mycompany.com Email: Example: no-reply@no-reply.com
1.5	Procedural request The Canadian Radio-television and Telecommunications Commission Rules of Practice and 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 the Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and the 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 :

2. Ownership

Definitions:

⁽¹⁾NAME/SHAREHOLDER: If any of these persons hold public office, by election or appointment, indicate the office held under the name of the person(s).
⁽²⁾CITIZENSHIP: Specify Canadian or Non-Canadian. A CANADIAN citizen, ordinarily resident in Canada, is as defined in the Direction to the CRTC (Ineligibility of Non-Canadians) P.C. 1997-486 as amended by P.C. 1998-1268.
⁽³⁾DIRECTORS: Defined in the Direction to the CRTC (Ineligibility of Non-Canadians) P.C. 1997-486 as amended by P.C. 1998-1268.
⁽⁴⁾OFFICERS: Those persons designated as Chairman, President, Chief Executive Officer, Vice-President, General Manager, Secretary, Assistant-Secretary, Comptroller, Treasurer, Assistant-Treasurer or any others under similar titles.
⁽⁵⁾CANADIAN: If a corporation, CANADIAN means a "qualified corporation" as defined in the Direction to the CRTC (Ineligibility of Non-Canadians) P.C. 1997-486 as amended by P.C. 1998-1268.)
⁽⁶⁾VOTING SHARES: The shares to which are attached one or more votes, and includes securities that are convertible into such shares at all times at the option of the holder.
⁽⁷⁾COMMON SHARES: The shares that represent the residual equity in the earnings of the corporation, and includes securities that are convertible into such shares at all times at the option of the holder and the preferred shares to which are attached rights to participate in the earnings of the corporation with no upper limit.
⁽⁹⁾ APPLICANT/SHAREHOLDER: Refers to a person who has reached the age of majority.

QUESTION 2.1 - TO BE COMPLETED IF APPLICANT IS A NOT-FOR-PROFIT CORPORATION; THEN PROCEED TO QUESTION 2.5.

2.1

Complete the following table providing a list of the directors and officers, including the Chief Executive Officer. The table should reflect the present or if not yet incorporated, the proposed board of directors and officers.

Name of the corporation for which the following table pertains:
DIRECTORS AND OFFICERS
Name⁽¹⁾	Complete Home Address	Citizenship⁽²⁾	Directors⁽³⁾: Date of Appointment	Officers⁽⁴⁾: Position Held

QUESTIONS 2.2 TO 2.6 - APPLICABLE IF APPLICANT IS A FOR-PROFIT CORPORATION.
2.2	Complete the following, providing:
	a)	A list of the directors and officers, including the Chief Executive Officer. The table should reflect the present or if not yet incorporated, the proposed board of directors and officers.

Name of the corporation for which the following table pertains:
DIRECTORS AND OFFICERS
Name⁽¹⁾	Complete Home Address	Citizenship⁽²⁾	Directors⁽³⁾: Date of Appointment	Officers⁽⁴⁾: Position Held

A table relating to the shareholders holding 10% or more of the voting shares⁽⁶⁾, of the voting rights (when different from the voting shares), and of the Common⁽⁷⁾ (participating) shares, by class of shares.

Name of the corporation for which the following table pertains:
CAPITAL STRUCTURE AND SHAREHOLDERS
Shares/ Units	Partici- pating (X)	Votes	Authorized	Issued	Name of Shareholders⁽¹⁾(company: provide jurisdiction) (individual: provide complete home address)	No. Held	% of Votes	Canadian⁽²⁾⁽⁵⁾(X)

A breakdown between Canadian and non-Canadian of the remaining shares not accounted for in b), by class of shares.

Name of the corporation for which the following table pertains:
Class of Shares	Shareholders	Total Number of Shares	% of Votes	Canadian⁽²⁾⁽⁵⁾(X)

2.3	Complete the following tables for each corporation holding, directly or indirectly, 20% or more of the voting interest (shares and/or votes) of the applicant:
	a)	A list of the directors and officers, including the Chief Executive Officer.

Name of the corporation for which the following table pertains:
DIRECTORS AND OFFICERS
Name⁽¹⁾	Complete Home Address	Citizenship⁽²⁾	Directors⁽³⁾: Date of Appointment	Officers⁽⁴⁾: Position Held

Name of the corporation for which the following table pertains:
CAPITAL STRUCTURE AND SHAREHOLDERS
Shares/ Units	Partici- pating (X)	Votes	Authorized	Issued	Name of Shareholders⁽¹⁾(company: provide jurisdiction) (individual: provide complete home address)	No. Held	% of Votes	Canadian⁽²⁾⁽⁵⁾(X)

A breakdown between Canadian and non-Canadian of the remaining shares not accounted for in b), by class of shares.

Name of the corporation for which the following table pertains:
Class of Shares	Shareholders	Total Number of Shares	% of Votes	Canadian⁽²⁾⁽⁵⁾(X)

2.4

Complete the same tables as in 2.3 for each corporation holding, directly and/or indirectly, 20% or more of the voting interest (shares and/or votes) of the corporations listed in 2.3 b), and for any corporation forming part of their ownership chain.

QUESTIONS 2.5 AND 2.6 -- TO BE COMPLETED ONLY WHERE THE COST OF THE UNDERTAKING EXCEEDS $250,000.
2.5	Specify the funds available to finance the proposed undertaking:
		Equity: Debt: Total:
2.6	a)	Specify the individual sources of financing for the funds identified in question 2.5 (for example, Bank loans, share capital, other loans). If any of these persons hold public office, by election or appointment, indicate the office held under the name of the person(s).

SOURCE	$

Where financing is to be provided, in whole or in part, through debt securities, provide the list of proposed debt holders, including names, citizenship or jurisdiction of incorporation (or other form of constitution), designation and description of debt securities held, and the principal amount of each one.

SUPPORTING DOCUMENTS TO BE APPENDED:
APPENDIX 2A	A copy of all constituting documents (for example, Articles and Certificates of Incorporation, By-Laws, Partnership or Trust Agreement) relating to the applicant and each corporation or other legal entity identified in questions 2.1, or 2.2, 2.3 and 2.4 (provide draft documents where a corporation is not yet incorporated). If the constituting documents have been filed with the Commission and no changes have occurred since, provide reference to the application that contains the most recent documentation together with a declaration attesting that the information is still accurate and valid as of the date of the filing of the application.
APPENDIX 2B	A statement regarding who controls/will control the applicant and by what means; if control is to be held by a shareholder company, also advise who controls/will control it and by what means; if applicable, attach all related documents or agreements (for example, Shareholder Agreement, Voting Trust Agreement).
APPENDIX 2C	If the applicant has delegated or will delegate by contract any responsibility, copies of the contracts (or proposed contracts). If applicable, indicate the legislative authority under which the corporation or other legal entities to such contracts are incorporated or otherwise constituted.
APPENDIX 2D	Documentation supporting the availability of each source of financing identified in question 2.6 if the cost of the undertaking exceeds $250,000. (NOTE:
	a)	Where funds are to be provided, directly or indirectly by a third party institution such as a bank, credit union, etc., submit a signed letter on the institution's stationery containing the following information:
			We have examined the financial projections of (Name of applicant) related to the application(s) before the Commission for a licence(s) to provide (type of service) to (location(s)) and we would be prepared to provide financing in the amount of ($) under the following terms and conditions (specify ALL the terms and conditions), subsequent to a favorable decision by the Commission, for the purpose of providing capital and operating funds related to the undertaking(s)."
	b)	Where funds are to be provided by an individual(s) whether for the purchase of share capital and/or the provision of debt securities, submit a signed statement of net worth from each individual, prepared and notarized within 3 months of the filing of the application.
	c)	Where funds are to be provided, directly or indirectly, by a corporation or other legal entity other than the applicant or institutions in (a) or (b) above, submit the audited financial statement of the entity for its most recently completed year of operation, and interim financial statements for the period ending within six months of the filing of the application.)

3. Industry consolidation and cross-media ownership

QUESTION 3.1 - TO BE COMPLETED IF APPLICANT IS A FOR-PROFIT CORPORATION.
3.1	Provide a list of all entities involved in any of the areas listed below, for which any investment (equity and/or debt securities) is held by the applicant, a corporation which directly or indirectly controls the applicant and any shareholder holding 20% or more of the voting shares and/or votes (participating and common shares) of the applicant:
	a)	Other CRTC licence holder and exempted undertakings
	b)	Daily newspaper
	c)	Non-daily newspaper or other media publisher
	d)	Production or distribution of programming material
	e)	Lessor of property, plant or equipment of applicant
	f)	Telecommunications company regulated under the Telecommunications Act
	g)	Company owning securities in any of categories (a) to (f)

4. Financial operations

4.1	In accordance with Generally Accepted Accounting Principles (G.A.A.P.), complete the following summary of the estimated annual revenue and expenses for each 12-month period ending 31 August of the proposed licence term.
	THE FIRST YEAR OF OPERATION WILL BE: ___________________________

	YEAR 1	YEAR 2	YEAR 3	YEAR 4	YEAR 5	TOTAL
REVENUE (after agency commissions) ($000)
Local Time Sales
Other (Specify)
TOTAL REVENUE
OPERATING EXPENSES ($000)
Programming
Technical
Sales, Advertising and Promotion
Administration and General
TOTAL OPERATING EXPENSES
NON-OPERATING EXPENSES ($000)
Depreciation
Interest
Other Adjustments - Expenses (income)
TOTAL NON-OPERATING EXPENSES
TOTAL EXPENSES
Estimated pre-tax income (loss)
Provision for Income Taxes
NET INCOME (LOSS) AFTER TAXES (for broadcasting operations only)

4.2

PROGRAMMING EXPENSES

In accordance with Generally Accepted Accounting Principles (G.A.A.P.), complete the following summary of the estimated annual operating expenses for programming and production for each 12-month period ending 31 August of the proposed licence term (refer to Public Notice CRTC 1993-93).

		YEAR 1	YEAR 2	YEAR 3	YEAR 4	YEAR 5	TOTAL
PROGRAMS TO BE TELECAST ($000)
1	Canadian programs - local
2	Canadian programs - non-local
3	TOTAL - CANADIAN PROGRAMS
4	Non-Canadian Programs
5	TOTAL - PROGRAMS TO BE TELECAST (lines 3+4)

4.3	Provide a detailed listing of all the basic underlying assumptions upon which the financial projections in questions 4.1 and 4.2 have been prepared, including the following:
	a)	The amount of revenues included in each of the years from non-traditional forms of advertising such as product placement, sponsorship messages and digital superimposition. Indicate where these revenues have been accounted for in the projections;
	b)	The methodology used to amortize program costs; and
	c)	Expected inflation rates and whether the projections have been prepared using current or constant dollars.
4.4	Provide a pro forma statement of changes in financial position for each year of the proposed licence term for the undertaking.
4.5	Provide a statement of pre-operating costs for the period prior to the commencement of operation.

5. Marketing

5.1

Provide quantitative estimates of the population within the service contours, as well as an estimate of the population within the area to which the station's principal marketing activities will be directed:

	GRADE A CONTOUR⁽¹⁾	GRADE B CONTOUR⁽¹⁾	PRINCIPAL MARKETING AREA
Population
Households

⁽¹⁾	Applicable only to Community-based low-power television undertakings

5.2	Identify the sources from which population data has been obtained:
5.3	Provide your audience projections:

FOR ALL PERSONS AGES 2+	YEAR 1	YEAR 2	YEAR 3	YEAR 4	YEAR 5
Weekly hours of viewing
Share of weekly hours of viewing

5.4	Indicate to which communities the station's principal marketing activities will be directed.
5.5	Describe the target audience in terms of its size and composition.

6. Technical information

Applicants are advised to consult with their broadcast engineering consultants when completing this section, to ensure that it is consistent with the Engineering Brief submitted to Industry Canada.

6.1	If the proposed service is for a full-power community-based station, demonstrate how the undertaking will be serving a remote community.
6.2	a)	Have all required technical documents been filed with Industry Canada?
			YES ( )	NO ( )
	b)	I hereby authorize the Commission to include as part of this application any documents or correspondence filed with Industry Canada with respect to this application.
			YES ( )	NO ( )
		If NO, explain.
6.3	Please provide the following technical information:

	PROPOSED OPERATION	NOTE
TV Channel		Channel number
Class (for UHF)		A, B, C
Antenna Mode		Directional, Non-directional
MAXIMUM ERP - Effective Radiated Power (at beam-tilt angle)	Visual (Watts) Aural (Watts)	If no beam-tilt is used, provide ERP in horizontal plane
AVERAGE ERP - Effective Radiated Power (at beam-tilt angle)	Visual (Watts) Aural (Watts)	If no beam-tilt is used, provide ERP in horizontal plane
EHAAT - Effective Height Above Average Terrain	metres
Transmitter/Antenna Site Co-ordinates:	N. W.	North Latitude West Longitude
Main Studios Location: Co-ordinates:	N. W.	City and, where possible, street address North Latitude West Longitude
Auxiliary Studio Location, if any		City and, where possible, street address
VBI - Vertical Blanking Interval Service	YES ( ) NO ( )	Use(s)
SAP - Second Audio Program	YES ( ) NO ( )	Use(s)
Programming Feed Method(s) from network or other sources		Off-air reception, microwave satellite, fibre-optic cable, other (specify)
STL - Studio to Transmitter Link Method		Microwave, fibre-optic cable, VHF/UHF radio link (specify)

6.4	Describe the transmission site and tower (antenna supporting structure) that you intend to use for the proposed television undertaking.
6.5	Is the proposed transmitter/antenna site an existing transmission site?
		YES ( )	NO ( )
6.6	Does the applicant propose to share existing facilities (tower, antenna, building, etc.)?
		YES ( )	NO ( )
	If YES,
	a)	state the owner(s) of these existing facilities;
	b)	indicate who are the other users of these facilities; and
	c)	provide details of the facilities.
6.7	ESTABLISHMENT COSTS
	In completing the following table, the costs to be entered are to include the total costs to put the asset(s) in place and ready for service, including all applicable taxes but excluding amounts budgeted for pre-operating expenses. Where the facilities are to be implemented at an existing site, indicate the cost of changes to items already in place (that is, the incremental cost) and the full cost for new items. Where a new site is to be developed, indicate the full cost of each item. Where assets are to be leased or rented, indicate both the Fair Market Value (FMV = the installed cost if the asset were to be purchased) of the asset(s) to be leased or rented and the annual lease or rental payments. Operating lease and rental are to be accounted for annually in the applicable operating expense category(ies) in Section 4. Capital leases are to be capitalized and amortized annually in the category of "Depreciation" in question 4.1. The cost of lease improvements should be indicated under Cost of Assets to be purchased.

	Costs of Assets to be purchased ($)	Value (FMV) of Assets to be leased ($)	Annual Lease Payment ($)
Studio Plant
Transmitting Plant
Contingency Allowance
TOTAL

(Note: Capital and/or lease costs of facilities dedicated to Administration and General operations may be included under Studio Plant).

6.8	Do the costs listed for the studio plant in Question 6.7 include provision for administrative facilities?
		YES ( )	NO ( )
	If YES, state percentage of the Studio Plant costs: ( %)
6.9	STUDIO AND ADMINISTRATIVE FACILITIES Provide a brief description of the proposed studio and administrative facilities.
6.10	DESCRIPTION OF TRANSMITTING FACILITIES Provide a brief description of the proposed transmitting plant:
	a)	Transmitter type and rated power;
	b)	Antenna type, number of bays and power gain; and
	c)	Antenna supporting structure (tower).
QUESTIONS 6.11 AND 6.12 -- APPLICABLE ONLY TO THOSE APPLYING FOR A LICENCE TO CARRY ON A COMMUNITY-BASED DIGITAL SERVICE BY CABLE DISTRIBUTION.
6.11	PROPOSED SERVICE AREA
	Please indicate the area you propose to serve, and the name and location of the cable operator(s) who would need to distribute your service in order to serve this community.
6.12	Is the service area proposed by the applicant the same as the licensed service area(s) of the cable operator(s) identified above?
		YES ( )	NO ( )
	If NO, provide information requested at Appendix 6A.

SUPPORTING DOCUMENTS TO BE APPENDED:
APPENDIX 6A	For a community-based digital service, if response to question 6.12 is NO, provide two (2) original versions of a map clearly showing the area to be served, preferably using a 1 : 50,000 scale Natural Resources Canada issue map.
APPENDIX 6B	a)	a map indicating the location of the transmitter/antenna site. Use an original or clearly legible copy of a 1 : 50,000 scale Natural Resources Canada issue map; and
	b)	clearly legible copies of the maps required in the Engineering Brief submitted to Industry Canada and which show the locations of the Grade A and Grade B service contours.
	The Commission encourages you to submit your proposed coverage area contours in a geographical information system (GIS) compatible file format (for example, .mid./.mif, .tab, .dxf, .dwg, .e00, .shp, .dgn). Also provide the map datum and projection used. This file can be submitted by using our electronic form or on a diskette.
APPENDIX 6C	Documentation supporting the availability of the proposed transmitter site(s).

7. Programming

All applicants must answer the following questions except where otherwise indicated.

7.1	Community television
The Commission has set out the provisions and requirements for community channels operated by terrestrial distribution undertakings in its Community Telvision Policy, Broadcasting Regulatory Policies CRTC 2010-622, 26 August 2010, and in Community Television Policy - Correction, Broadcasting Regulatory Policy CRTC 2010-622-1, 13 September 2010. Please confirm that the licensee will adhere to the applicable provisions (i.e. requirements, expectations and/or encouragements) set out in Broadcasting Regulatory Policies CRTC 2010-622 and 2010-622-1, by condition of licence. Yes ( ) No ( ) If no, specify the requirements, expectations and/or encouragements you propose to amend with a detailed rationale in support of any such amendment, including, where appropriate, financial evidence, and propose wording for alternative requirements, expectations and/or encouragements For the licensee that elect to distribute a community channel, outline how you are operating fully in accordance with the provisions set out in the Community Television Policy, particularly with respect to : Roles and objectives Local community television programming Community programming Access programming Accountability and reporting For licensees that provide community programming in the greater Toronto, MontrÃƒÂ©al and Vancouver areas, outline how you reflect the various geographic communities within your licensed areas in these urban centers, and which commitments you have undertaken.
7.2	LANGUAGE OF PROGRAMMING
	The principal language of programming will be: ____________
7.3	Cultural Diversity
	a)	Describe how the proposed programming (news and non-news) will reflect the presence of cultural and racial minorities and Aboriginal people in the communities served, in a manner that is accurate, fair and non-stereotypical.
	b)	Describe any specific commitments to initiatives designed to ensure an accurate and fair reflection and portrayal of all minority groups.
7.4	BROADCAST DAY
	Section 2 of the Television Broadcasting Regulations, 1987, defines the "broadcast day", as the period of up to 18 hours, beginning each day not earlier than six o'clock in the morning and ending not later than one o'clock in the morning of the following day, as selected by the licensee.
	The applicant proposes the following broadcast day:

FROM:

TO:

7.5	LOG REPORTING DAY
	Each broadcaster must choose a time that they will use as the absolute beginning and ending of each log reporting day. The chosen log reporting day must be a complete 24 hour period commencing at or before the beginning of the broadcast day and ending at or after the close of the broadcast day.
	The starting time of your "log reporting day" will be: ___________

SERVICE TO THE HEARING IMPAIRED
7.6	Will the applicant install a Telephone Device for the Deaf (TDD)?
		YES ( )	NO ( )
	If YES, where will it be located?
	If NO, provide reasons.
SERVICE TO THE VISUALLY IMPAIRED
7.7	What plans do you have to meet the needs of the visually impaired, for example, providing audio descriptions of programming?

QUESTION 7.8 -- APPLICABLE ONLY TO THOSE APPLYING FOR A LICENCE TO CARRY ON A COMMUNITY-BASED DIGITAL SERVICE.

7.8	OTHER PROGRAMMING REQUIREMENTS
	The applicant accepts, as a CONDITION OF LICENCE, to adhere to the following sections of the Television Broadcasting Regulations, 1987:
	Ã¢â‚¬Â¢	Section 5, related to "Programming Content"
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Section 6, related to the broadcasting of commercial messages dealing with alcoholic beverages
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Section 8, related to "Political Broadcasts"
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Section 10, related to "Logs and Records"
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Section 11, related to "Advertising Material"
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Section 12, related to the requirement to submit an annual return (standard filing requirements)
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Section 14, related to changes in ownership of the licensee
		YES ( )	NO ( )
	Ã¢â‚¬Â¢	Broadcasting Licence Fee Regulations, 1997 (if revenues exceed the threshold amount of $2 million)
		YES ( )	NO ( )
	If you responded "NO" to any of the above, provide reasons.

SUPPORTING DOCUMENT TO BE APPENDED:
APPENDIX 7A	PROGRAM SCHEDULE A copy of the station's proposed Block Program Schedule, including the country of origin of all programs. In the Program Schedule, mark programs on the following basis (refer to Public Notices 1999-97 and 1999-205 for information regarding priority programs):
	a)	Priority programs with a "P";
	b)	Programs produced specifically for local audiences with an "L"; and,
	c)	Network or group productions with an "N" or "G" as appropriate.

8. Employment equity

Information relating to employment equity is available in Public Notices CRTC 1992-59 and 1997-34.

8.1	If the proposed undertaking is approved, would the licensee be subject to the 1996 Employment Equity Act (applicable to federally-regulated employers with 100 or more employees)?
		YES ( )	NO ( )
	If YES, proceed to section 9, "On-air Presence". If NO, proceed to question 8.2.
8.2	If the undertaking is approved, would the licence be held by a licensee that already holds one or more broadcasting licence(s)?
		YES ( )	NO ( )
	If YES, proceed to question 8.3. If NO, proceed to question 8.7.
8.3	Outline examples of any measures (including hiring and training, apprenticeship programs, work arrangements, etc.) that you have or will put in place for the designated groups (women, Aboriginal peoples, persons with disabilities and visible minorities).
QUESTIONS 8.4 TO 8.6 -- APPLICABLE IF BETWEEN 25 AND 99 EMPLOYEES ONLY:
8.4	How do you or will you communicate details of your employment equity policies to managers and staff?
8.5	Have you assigned or will you assign a senior level person to be responsible for tracking progress and monitoring results?
		YES ( )	NO ( )
	If YES, what authority does or will that person have to ensure goals are achieved?
8.6	What financial resources have you or will you put in place to promote employment equity in the workplace (for example, funds for daycare, access for persons with disabilities, etc.)?
QUESTIONS 8.7 AND 8.8 -- APPLICABLE IF RESPONSE TO QUESTION 8.2 IS "NO"
8.7	To what extent will the proposed undertaking address the equitable representation of the four designated groups (women, Aboriginal peoples, persons with disabilities and visible minorities)?
8.8	Does the proposed undertaking have an employment equity (EE) plan?
		YES ( )
	If YES, please describe the principal measures proposed to recruit and assist members of the four designated groups (for example, work arrangements, apprenticeship or training programs, career counselling, etc.).
		NO ( )
	If NO, please provide a statement indicative of your commitment to develop and implement an effective EE plan.

9. On-air presence

Information relating to on-air presence and voice-overs is available in Public Notices CRTC 1994-69 and 1995-98.

25 OR MORE EMPLOYEES:
9.1	If the undertaking is approved, would the licence be held by a licensee that already holds one or more broadcasting licence(s)?
		YES ( )	NO ( )
9.2	Outline policies and procedures in place, or plans in this regard, to ensure the representation of members of the four designated groups in on-air positions, including voice-overs, where applicable. These policies, procedures and plans should include references to programs produced by the applicant, as well as to acquired programming and advertising.

10. Request for documents to be designated as confidential

Sections 30 to 34 of the Canadian Radio-television and Telecommunications Commission Rules of Practice and 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:

Information that is a trade secret
Financial, commercial, scientific or technical information that is confidential and that is treated consistently in a confidential manner by the person who submitted it; or
Information the disclosure of which could reasonably be expected :
1. To result in material financial loss or gain to any person;
2. To prejudice the competitive position of any person; or
3. To affect contractual or other negotiations of any person.

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 the Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and the Procedures for filing confidential information and requesting its disclosure in Commission proceedings, Broadcasting and Telecom Information Bulletin CRTC 2010-961, 23 December 2010, for complete process for filing confidential information.

10.1 Request for documents to be designated as confidential

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 :

Book of supporting documents

APPENDIX NUMBER AND NAME		APPENDED (Yes or No)	E-FILED (Yes or No)
SECTION 1: GENERAL INFORMATION
1A	Supplementary Brief
SECTION 2: OWNERSHIP
2A	Constituting Documents (or drafts)
2B	Statement on Control of Applicant
2C	Delegation of Responsibility by Contract
2D	Documentation Supporting Availability of each Source of Financing
SECTION 6: TECHNICAL INFORMATION
6A	Maps - Proposed Service Area (if different from cable operator(s))
6B	Maps - Proposed Coverage Contours
6C	Documentation Supporting the Availability of the Proposed Transmitter Site(s)
SECTION 7: PROGRAMMING
7A	Block Program Schedule

This document is available in alternative format upon request.
CRTC 116 (2011-07-15) - New - Community-based TV
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