2025-2026 Regina Brindle Grant Application Form

Applicant information
Are you applying as an:*

IndividualA small group of individuals
Name of the contact person for the application*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
If you are a small group, you must provide a second contact.

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
If you are a small group, please include a name for your group.

Project information
What is the name of the project *
Provide a short summary of the project (50 words)*

0/50

Project beneficiaries
Who will the project benefit? (Tick all that apply)*

People with experience accessing AOD servicesPeople with experience accessing MHW ServicesPeople with experience accessing services to get help with their gambling
Describe your lived and/or living experience and your connection to the community you will work with when completing your project.*

0/300
Is your project designed to benefit a particular group or groups (for example, young people living in regional areas, people living with a disability, culturally and linguistically diverse people in the LGBTIQA+ community, Aboriginal and/or Torres Strait Islander women)?

0/300

What is the intended start date of your project? The project cannot start before 27th March 2026. *

MonthDayYear
Date
What is the intended completion date of your project? The project funded activities must be completed within a 12 month period, by 27 March 2027. *

MonthDayYear
Date
Describe what you are going to do. Include a timeline of the key activities. *

0/300

How does your project meet the aims of the Regina Brindle Grant Program?

Please include responses to at least two of the aims listed below.
Promote the consumer voice

0/200
Address barriers to social inclusion experienced by AOD and/or Mental Health and wellbeing consumers and/or their family, friends and supporters.

0/200
Promote community engagement and education

0/200
Reduce stigma and discrimination

0/200
Promote human rights

0/200

Project outcomes and risks
What impact/s will your project have on the lives of consumers, and/or family, friends and supporters and/or the broader community? *

0/300
Are there any risks related to the project? How will you manage the risks? Please describe. *

0/300

Budget
What is the total amount you are requesting from this grant? The amount must be not less than $1,000 and no more than $5,000.*
If you don't receive the full amount of funding requested, will the project still be able to go ahead?

YesNo
Now it is time to add your budget spreadsheet to your application using the Regina Brindle Grant budget template. The template is available here.
Upload your budget using our template. *

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References
Reference 1

First NameLast Name
Reference 1: Email
example@example.com
Reference 1: Phone

Area CodePhone Number
Reference 1: Relationship to you and/or the project.
Reference 2: Name

First NameLast Name
Reference 2: Email
example@example.com
Reference 2: Phone Number

Area CodePhone Number
Reference 2: Relationship to you and/or the project
Optional: Do you have any supporting documents, photos, media or references that you would like to add to support your application? Please upload up to 3 documents here.

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Privacy and certification
All information in this application will be provided to each member of the Regina Brindle Grant Program Committee to assist them in processing your grant application.

The Regina Brindle Grant Program Committee will use any personal information provided by you for the purpose of processing your grant application and for remaining in contact with you.

By submitting this application, you consent that, if successful, the Self Help Addiction Resource Centre (SHARC) can publish your name, project description and the awarded amount in our public communications. This information may also be used to promote the Regina Brindle Foundation Grant Program.

By submitting this application, the applicant agrees that:
- All information and statements provided in this application are true
- Regina Brindle Grant Program does not accept any liability or responsibility for the project
- If successful, you will provide a final report by the project completion date stated in your project application
Should be Empty:

Regina Brindle Grant Program

Are you eligible?

Applicant information

Project information

Project beneficiaries

How does your project meet the aims of the Regina Brindle Grant Program?

Project outcomes and risks

Budget

References

Privacy and certification