Blue Light Champions Events Fund application form
About you
Name:
Best daytime contact number:
Service:
Role:
Email address:
Region:
England
London (including Greater London)
South East
South West
East of England
East Midlands
West Midlands
Yorkshire and the Humber
North East
North West
Cymru/Wales
De Cymru/ South Wales
Gwent
Dyfed Powys
Gogledd Cymru/ North Wales
Your details for BACS payment
If you are successful we will pay you by BACS directly into your bank account. In order to make this process as quick as possible please provide us with the below (if BACS isn’t suitable for you please get in touch at )
Account number:
Sort code:
How long have you been a Blue Light Champion?
Under a month
1-6 months
6 months – 1 year
1 – 2 years
2 – 3 years
Over 3 years
Do you have personal experience of a mental health problem? Yes/No/Prefer not to say
We are asking this question for monitoring purposes.Please note your answer will not affect your application. The fund is open to all Blue Light Champions, whether or not you have personal experience of mental health problems.
Other Blue Light Champions:
Let us know about any other Blue Light Champions who will be directly helping you with the event if you are successful. You can enter up to five people, please let us know their first and last names. We encourage you to nominate one person who is happy to lead on the event should you need to take a step back for any reason. Please put a note against the person this will be.
Your event – your application will be assessed based on the following questions
  1. Tell us about your event
Name of event:
Event summary:
Please tell us using up to 500 words (please note that we will only be able to assess up to 500 words)
Please write your answer here:
  1. Do you have a recommendation of support from someone in your service?
This could be your line manager, other individual involved in wellbeing, someone in HR or involved with staff engagement. Please submit a letter or email from this person along with your application if you have been able to obtain this.
Please note this is a requirement you have to meet.If you have not been able to get this please still submit your application, but we will need you to obtain this before you can receive a grant from the fund.
Please write your answer here:
  1. How will your event achieve at least three of the below for Champions.Please state which points your event will focus on and why:
  1. Strengthen connections between themselves
  2. Look after their wellbeing
  3. Share best practice and learn something new
  4. Trouble shoot any issues they are currently having
  5. Celebrate how amazing they are and what they have achieved!

Please write your answer here:
  1. When will your activity take place?
We are able to fund events that will take place between April and December 2018.Please write the date in the format DD/MM/YY.
  1. Where will your activity take place?
If you have a full address please put it below, if not please give us as much detail as possible.
People
  1. How many Blue Light Champions are you hoping willattend your event?

  1. How will you promote your activity and make it accessible for Blue Light Champions in your service and area?
Please consider internal and external promotion. For example, if it is appropriate for your event, you may like to think about inviting Blue Light Champions from other emergency services in your local area.

Please write your answer here:
  1. Will you be inviting any other people from your service or local organisations to your event, such as your pledge lead or local Mind?
We are looking to fund events where Champions are the main attendees, however we encourage you to use this as an opportunity to build links around mental health within your organisation and local community.
Please write your answer here:
  1. How will you make sure Blue Light Champions are supported during your event?
Please write your answer here:
  1. How will your event engage with a wide range of people, such as people from the LGBTQ+ community or your disability network, and encourage them to help raise awareness and possibly sign up as Champions?
Please write your answer here:
  1. Will you be able to organise your event within work time?
Its Mind’s policy to pay people who share their time and expertise to influence our plans or who contribute to the work we deliver.
We really value your time, expertise and contribution to support Blue Light Champions within your organisation. If you undertake organising this event outside of your working hours, you can set aside up to £100 engagement payment from your event budget for your time and skills to organise the event (equivalent to seven hours).
Please note this will be included in the maximum of £500 that you can apply for and is optional. Although we understand the event organisation may take you more than seven hours in total to organise, £100 is the maximum we can allocate for your engagement time. The rates are outlined below.
1.5 – 3 hrs - £25
3.5 – 5 hrs - £50
5.5 – 7 hrs - £100
If you would like to apply for an engagement payment please ensure this is in line with any organisational policy your service may have regarding organising events.
I will be organising the event in work time
I will be organising the event in my own time
I will be organising the event in my own time and am applying for an engagement payment
  1. What added value is your service able to bringto your event?
This could be by offering you a free venue, allowing you work time to organise the event, help from your communications team to promote your event, by funding part of the event, or a member of the senior leadership team attending or supporting the event.
Please write your answer here:
  1. If you are not successful but another Champion in your service or area is, would you like to be put in touch with them?
Yes - I am happy for you to send them my email address to get in touch with me about their event.
No thank you.
Your budget
  1. Your budget
Use the table below to tell us how much your activity is going to cost.
  • Table 1 is an example budget, to help show you how to complete the table.
  • Table 2 is the table you need to fill in. Make sure you check that the totals have been added up correctly.
If you would like materials from the Blue Light Programme for your event please include these in your budget and contact us if you need further information about costs.
Table 1: Example budget
Item / Cost / How have you worked out this cost? / Enter an X in the box below if you are asking us to fund this item.
If you have other funding to pay for an item or part of an item please say where it is coming from.
Example budget
Venue cost / £75 / Quote from venue / X
Engagement payment for my time / £50 / 5 hours of my time / X
Refreshments / £50 / Will cost £2 per person / Donated by organisation
Art materials / £100 / Went to art shop and noted how much each item costs / X
Printing
Total cost for activity / £275 / Total of all lines in the cost column
Total of lines in the cost column with an X in the final column
Total you are asking for from the Blue Light Champions events fund / £225
Table 2: Your budget
Item / Cost / How have you worked out this cost? / Enter an X in the box below if you are asking us to fund this item.
If you have other funding to pay for an item or part of an item please say where it is coming from.
Please enter your budget below
Please add more lines if needed
Total cost for activity / Total of all lines in the cost column
Total of lines in the cost column with an X in the final column
Total you are asking for from the Blue Light Champions events fund

If you are successful we will require you to retain receipts for items in your budget that cost over £35, and submit these along with a short evaluation for monitoring purposes, within four weeks of your event taking place.

Name:

Signature:

Date:

Thank you for taking the time to complete this application form and apply to the Blue Light Champions events fund. Please email your completed form along with your Mind Demographic monitoring form found hereto by 9am on Monday 29th January 2018. We will confirm receipt of your application via email. We’ll then be in touch to let you know if you’ve been successful or not by the end of February 2018.

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