PLEASE READ THE MHW EVENT PLANNING KIT PRIOR TO COMPLETING THIS FORM AVAIL ABLE VIA
Mental Health Week 2017: Grant Application Form
Event Name:Organisation:
Key Contact Person:
Address: / Postcode:
Email:
Phone:
Which grant amount are you applying for?
(please circle)
$2000 / $1500 / $1000 / $750 / $500
Please provide a brief description of your proposed Mental Health Week event or activity.
Expected date and time of your event: / Expected location of your event:
Please provide a brief description of the target audience for your activity
How many people you expect to be involved in attendance of your event. (not including those delivering the event)
How will you promote the event?
How will the event demonstrate the in the theme of mental health week ‘Stronger Together’?
Do you have any evidence to support the effectiveness of your event or activity?
How will this event engage people in the community not already linked to the mental health sector/services?
What organisations or agencies are you partnering with to deliver this event?
How will you evaluate your event or activity?
Will your activities be covered by Public Liability Insurance?
Please attach an indicative budget for your event showing the major items on which grant funding would be spent. [BUDGET TEMPLATE at ]
Application Compliance and Checklist
You need to initial each of these to show that you agree to these terms.
I have completed all parts of the application form.I have included a budget.
I have indicated the grant I am applying for.
I acknowledge that if I am successful in receiving a Mental Health Week grant I am prepared to stage my event during Mental Health Week (9-14 October 2017) unless otherwise agreed upon with the Mental Health Council ofTasmania
I acknowledge that if I am successful in obtaining a grant it has been awarded on the merit of this application therefore if there are any changes to my event following submission of this application OR receipt of a MHW grant I will inform the Mental Health Council of Tasmania of these changes as a matter of priority.
I acknowledge that where there are significant changes to my event application the selection panel have the right to review allocation of grant funding based on those changes.
I acknowledge that the selection panel have the right to consider equitable distribution of funds across the state in their assessment of grant applications.
I acknowledge that the selection panel may offer part funding and/or attach conditions to the allocation of grant funding.
I acknowledge that if my application is successful I will nominate ONE key contact from their event to liaise with the Mental Health Council in relation to event matters.
I acknowledge that if successful I will be required to provide evidence of appropriate acquittal of funding.
I acknowledge that if successful I will be required to evaluate my event and provide a brief summary of the evaluation to MHCT within two months of Mental Health Week.
I acknowledge that if successful in receiving a grant I MUST display theMental Health Council Logo and the State Government Logo on promotional material and adhere to the Mental Health Week theme guidelines in the promotion of my event
(please see for theme guidelines in the media and event kits)
Please sign and agree to the below statement.
Applications that do not sign their application by a representative of their organisation will be deemed ineligible.
Applications for funding open on the 22 June 2017 and close on the 21 July 2017
Applications can be submitted by email to by no later than 5:00pm on Monday 21 July.
Applications which are not successful will be notified in writing and a debriefing session will be available upon request.
All applications will be assessed by a selection panel comprising of MHCT Media and Communications Lead, Arepresentative from The Mental Health Drug and Alcohol Directorate, a consumer representativeand a carer representative.
Successful applicants will be notified and asked to produce an invoicefor the amount to be received plus GST. Once this is received the payment will be processed byMHCT.
I agree to the above conditions of the application process and can assert that all information provided in this application is true and accurate at the time of submitting.
Signed:
Print Name:
Organisation:
Date: