Facilitator Training Scholarship Application
Organization Information
Organization Legal Name:
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Organization Doing Business as Name (if different than Legal Name)
Employer Identification Number:
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Is the Organization a Registered 501(c)3?
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Yes
No
Street Address, State, Zip Code:
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County:
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Main Phone Number:
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Website:
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Executive Director Name:
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Executive Director Email:
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Executive Director Phone:
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Applicant Details
Applicant Contact Name (if different than Executive Director):
Applicant Contact Title:
Applicant Contact Email:
Applicant Contact Phone:
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Scholarship Qualification Questions
All Stronger Together Peer Support Model™ (Bellis) groups must be facilitated by a trained, licensed social worker, therapist, drug/alcohol counselor, parent educator, or similarly qualified professional. Please direct any questions you have about your employee qualifications to Bellis staff via email (info@mybellis.org) before applying for this scholarship.
Do you employ a licensed professional(s) who will be able to facilitate Bellis groups?
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Yes
No
How many facilitators would you like to be trained?
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Scholarship Narrative Questions
Introduce your organization, its mission, values, and goals.
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Please enter at most 3000 characters.
0/3000
Please describe the population your organization supports.
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Please enter at most 3000 characters.
0/3000
Please describe the workplace culture of your organization.
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Please enter at most 3000 characters.
0/3000
What do you know about Bellis? Why will Bellis groups work at your organization?
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Please enter at most 3000 characters.
0/3000
How many Bellis groups will you offer at your organization? What is your timeline for implementing Bellis groups once your facilitators are trained?
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Please enter at most 1000 characters.
Are you willing to implement a community group available to participants outside your organization? If yes, will this be an in-person or virtual group?
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Please enter at most 1000 characters.
Please upload your organization's current budget.
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