2022 MHM ACT Reimbursement Grant application form

MENTAL HEALTH MONTH ACT Reimbursement Grant application form
Are you ready to apply for a 2022 Mental Health Month ACT Reimbursement Grant?

Before you start your application, make sure that you have:
1. read the advice in the Application guidelines , including who can apply and how the grant can be used
2. developed an event plan in line with the Mental Health Month objectives and theme
3. developed a detailed budget to determine how much funding you need to apply for, noting that funding is reimbursed after the event
4. considered COVID safety planning and how your event might need to change if there is an outbreak and restrictions in place.
If you have any questions, please contact communications@mhccact.org.au.
Contact details
Full name *
Organisation name
Email address *
Phone number *

Area Code Phone number
Phone number: secondary

Area Code Phone number
Website
Event plan
Event name *
Event venue/location *
Event date *

Month Day Year
Event time
Expected attendance numbers
Event description (including event format, activities, timetable/run sheet, guest speakers/facilitators, target audience, topics covered) *
We encourage you to to include as much detail as possible to demonstrate the level of planning undertaken. You can also provide additional attachments at the end of this form.
I have attached further information on the project plan, timeline or run sheet (optional)
The objectives of Mental Health Month in the ACT are:
1. To raise community awareness and understanding of mental health
2. To reduce the stigma and discrimination associated with mental health conditions
3. To promote positive mental, physical, social and spiritual health and wellbeing in the community
4. To encourage people to seek help and practice self-care
5. To provide information about mental health and wellbeing and increase awareness of local services.
What are your event objectives, and how do they align with the objectives of Mental Health Month? *
How does your event align with the 2022 Mental Health Month ACT theme of ‘Awareness, Belonging, Connection’? *
Are you partnering with another organisation/s to coordinate the event? If so, please provide details.
Which of the following groups is your event aimed at? Check all that apply. *

lesbian, gay, bisexual, trans, queer, intersex and asexual (LGBTQIA+) people Aboriginal and Torres Strait Islander peoples people from culturally and linguistically diverse (CALD) backgrounds young people aged 12 to 25 years adults aged over 65 years children of parents affected by a mental illness people with a disability general community other isolated or at-risk groups (please specify)
How will you promote the event? *
Please note the event promotion requirements listed in the Application guidelines.
I do not wish to have the event included in the 2022 Mental Health Month ACT event calendar
Event budget

Fill out budget below for expected total costs for event, not just grant funding amount requested. You are welcome to attach a more detailed budget at the end if needed.
Venue
Catering
Speaker/presenter/facilitator/performer fees
Marketing, promotions and advertising
Printing and stationery
Supplies (e.g., equipment, art, tools)
Professional fees (e.g., design)
Other costs: description
Other costs: amount
Total event cost *
In-kind contributions (i.e. internal organisational costs)
Funding amount requested through the MHM ACT Reimbursement Grants program *
I have attached further information on the budget (optional)
If you are successful in your application but are offered less funding than you have requested, how could you scale down your proposal? *
As noted in the Application guidelines, we might choose to offer you less funding than you request. This will allow us to be flexible in how many grants we give so that we can provide events for as many Canberrans as possible.
COVID-19 safety
How will you ensure your event is COVID-smart? If COVID-19 restrictions are re-introduced at the time of the event, how will you adapt? *
Consider the impacts of measures like social distancing, attendance number restrictions, mask mandates and compulsory app check-ins.
*

I acknowledge that I am responsible for adhering to all COVID-19 restrictions and measures during this event if I am successful in receiving funding.
Agreement
*

I have read the reimbursement grant application guidelines and confirm that this application meets those guidelines This application is only seeking reimbursement for funds associated with organising, promoting and running an event, not for items that are part of my organisation’s core business (such as reimbursement for staff wages or other usual operational costs). If I am successful in my application for a Mental Health Month Reimbursement grant, I agree to notify the Mental Health Community Coalition ACT (MHCC ACT) in writing of any changes to the event date, time, plan or activities as soon as possible and before the event starts. I acknowledge that the funding is in the form of a reimbursement after the event, and requires evidence of spending in line with this application or approved changes before funds are provided.
Signature *

Clear
Today's Date *

Month Day Year
Date
Additional attachments (eg. project plan, detailed budget, accompanying documentation)

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MENTAL HEALTH MONTH ACT Reimbursement Grant application form

Contact details

Event plan

Event budget

COVID-19 safety

Agreement