Funding Request Form

November 12, 2008 - 15:00

What is the name of the activity:

What is the date of the activity:

Please provide specific details of the activity:

Who is involved in planning the activity:

Who is the activity designed for:

How many people do you hope to reach:

How is it related to Substance Abuse & Injury Prevention:

What is the message of you activity:

The SAP banner is provided for display at all activities. What other Substance Abuse Prevention materials do you plan to distribute and have available (i.e. Pamphlets, posters):

How much funding are you requesting:

Please provide a breakdown of expenses for which you are requesting funding:

If your event is a moneymaking event, what happens to the profits:

Is this a one-time event or will it require ongoing funding:

What are others contributing to the project? (Include in-kind stuff/volunteer time, hall & rental equipment, donations, use of own supplies & financial contributions):

What do you hope to achieve by hosting this activity:

Measuring the success of the activity is required. How are you going to measure/evaluate the activity:

Follow-up reports are required. Please ensure that you submit the follow-up report to Hugh Dennis after your event, or make arrangements with Hugh to present the report in person.
Furthermore, receipts and/or invoices for the event must be submitted to Substance Abuse Prevention within 60 days of the event for reimbursement. Failure to do so will void funding.
You can contact him at 274-9827 ext. 229, or hdennis@nwhu.on.ca

Name of Contact Person: *

E-mail Address:

Telephone Number of Contact Person: *

Address of Sponsoring Agency: *

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	Funding Request Form November 12, 2008 - 15:00 What is the name of the activity: What is the date of the activity: Please provide specific details of the activity: Who is involved in planning the activity: Who is the activity designed for: How many people do you hope to reach: How is it related to Substance Abuse & Injury Prevention: What is the message of you activity: The SAP banner is provided for display at all activities. What other Substance Abuse Prevention materials do you plan to distribute and have available (i.e. Pamphlets, posters): How much funding are you requesting: Please provide a breakdown of expenses for which you are requesting funding: If your event is a moneymaking event, what happens to the profits: Is this a one-time event or will it require ongoing funding: What are others contributing to the project? (Include in-kind stuff/volunteer time, hall & rental equipment, donations, use of own supplies & financial contributions): What do you hope to achieve by hosting this activity: Measuring the success of the activity is required. How are you going to measure/evaluate the activity: Follow-up reports are required. Please ensure that you submit the follow-up report to Hugh Dennis after your event, or make arrangements with Hugh to present the report in person. Furthermore, receipts and/or invoices for the event must be submitted to Substance Abuse Prevention within 60 days of the event for reimbursement. Failure to do so will void funding. You can contact him at 274-9827 ext. 229, or hdennis@nwhu.on.ca Name of Contact Person: * E-mail Address: Telephone Number of Contact Person: * Address of Sponsoring Agency: * CAPTCHA This question is for testing whether you are a human visitor and to prevent automated spam submissions. What code is in the image?: * Copy the characters (respecting upper/lower case) from the image.
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