$2500 Community Grant Form

(* Every section must be filled. )

Also note the DEADLINE DATE : SEPTEMBER 19th, 2011

BASIC INFORMATION

Name of Organization/Group: (required)

Name of Group/Organization: (required)

Event Coordinator Name: (required)

Event Coordinator's Telephone: (required)

Cell phone:

Supervisor's Name: (required)

Supervisor's Telephone: (required)

Supervisor's Email: (required)

Who to make cheque payable to (Cheques will not be made to individuals): (required)

Address: (required)

Fax:

Email: (required)

Website if available:

COMMUNITY DESCRIPTION
In one paragraph, tell us about your community: Why is it important for your community to promote addictions awareness? How would a NAAAW event make a lasting impact on your community?

COMMUNITY INVOLVEMENT IN PROPOSED EVENT
In planning a NAAAW event, it is important to have community partners involved to assist in the implementation and to spread the word that the event is happening. Who are your community partners? Which individuals or organizations are involved in your planning committee? How will these individuals and/or organizations be directly involved with your NAAAW event?

PROPOSED NAAAW 2011 EVENT
Describe in as much DETAIL as possible what you plan to do for NAAAW 2011. Please include what components of your event will specifically relate to youth, Elders, parents and the whole community with regard to culture, healthy living, additions education and prevention.

CREATIVITY
What sets your proposal apart in your approach to creating awareness and addressing issues of addictions and health promotion? Please include a timeline of events for each day throughout the week.

AWARENESS
Describe exactly how addictions awareness, prevention and health promotion will be the focus of each activity during NAAAW. Tell us how the activities target the specific addiction issues that exist in your community. How will you continue this momentum created during NAAAW?

FUNDING AND RESOURCES
It is important to remember that the success of NAAAW has always been the innovation and commitment of the people in the communities. NAAAW grants are intended to enhance addictions awareness events, not to fully fund them. How will you ensure your NAAAW event happens if you don't receive the grant? (NOTE: The grant does not cover capital costs such as purchasing of equipment, furniture, or wages. )

LONG TERM IMPACT
How will addictions awareness, prevention, and health promotion continue after NAAAW?

ROLE MODEL
Select a Role Model: individual, group, or family? How will you select the role model in your community? Consider what contributions your role model has made to your community. How does your role model inspire people to 'live the good life' in your community? How will you honor the NAAAW role model in your community?

LETTERS OF SUPPORT
Please include a MINIMUM of two letters of support. Letters of support should specify how the organization providing the letter plans to support your event. Note: When submitting letters of support please be sure to include the name of group/organization applying for the grant and the event coordinator's name.

You may fax them to 780-428-0187 or Email to: : nadine-mcree@ncsa.ca