Mental Health Week 2023 Small Grants Application Form

*Please note that you can use the 'Save and Continue' later option at the bottom of this form if you're unable to complete your application in one session. When you click the 'Save and Continue' option, you will be taken to a new page which has the link to continue your application. You either need to copy and save this link somewhere, or you can enter your email address and it will be sent to you.

General Information
Organisation/Group:*
Organisation website:
Event target Audience:*
(e.g. LGBTI, CALD, youth, rural/remote community)
Key Contact Name:*
First Last
Contact Email:*
Contact Phone Number:*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Your Mental Health Week Event
Event Name:*
Please provide the intended name of your event. You can change this via the event registration process later if required.
Event Description:*
Please provide a brief description of your proposed Mental Health Week event or activity (200 word limit)
Event Goals:*
Describe your event objectives/goals and how you plan to achieve them (200 word limit)
Event Date:*
Please note, events should be held within the Mental Health Week period 7-15 October. If there re circumstances that prevent you from hosting your event during this week, please let us know the reason below (e.g. it is school holidays)
Date Format: DD slash MM slash YYYY
Planned Event Start Time:*

: HH

MM
Event End Date:
(If you're event is planned to run over multiple days)
Date Format: DD slash MM slash YYYY
Planned Event End Time:*

: HH

MM
Is your event on a date outside of Mental Health Week (7-15 October)?*
- No
- Yes
If outside of Mental Health Week, please outline the reasons?
Event Location:*
How many people do you expect to attend your event?*
Partnerships:
Please describe any partnerships/collaboration with other organisations or agencies on this event (please provide organisation’s name/s) (200 word limit)
How do you plan to promote your MHW event to ensure its success?*
How do you plan to promote your MHW event to ensure its success, including targeting community members not already engaged with or linked to mental health services/sector? (100 word limit)
Event Theme:*
Describe how your event will incorporate the 2023 Mental Health Week theme, 'Awareness, Belonging, Connection' (200 word limit) (For more detail on how to incorporate the theme please see the event planning kit via www.mhct.org/mentalhealthweek)
Other Information
Grant Category:*
Please advise the MHW Small Grant category you are applying for. You can read more about each of the categories here. If you are unsure of which category to select, please get in touch either via email on [email protected] or phone on 6224 9222
- $500 - $1000 for small scale public event
- $1000 - $2000 for larger public events/activities
- Up to $500 for small targeted community group events
- Up to $750 for school community events
Event Budget:*
Please ensure your budget accounts for the amount you are applying for. In addition to items which will be grant funded, please also include other items relevant to your proposed event that would be covered by other funding sources (eg funded by the applicant, in-kind donations etc).
Item Cost Funding Source Purpose
Total of grant funding requested:*
Total Budget:*
(including items from other funding sources)
To help ensure you receive grant funds in a timely manner should your application be successful, please provide details for Electronic Funds Transfer:
Is your organisation registered for GST?*
- Yes
- No
Account name:*
BSB:*
Account number:*
Reference Number:
If you require a specific reference number for financial reconciliation purposes, please include it here. If not, a generic one will be allocated to you.
Grant Evaluation and Acquittal*
Are you willing to complete the official MHW Small Grant Evaluation and Acquittal form after your event? (this will be sent to you should your application be successful)
Application Compliance and Checklist
Please read and tick all boxes to show you understand and agree to these terms.
I have completed all sections of the application form*
Yes
I have included a budget*
Yes
I acknowledge that if I am successful in receiving a Mental Health Week grant I am prepared to stage my event during Mental Health Week (7-15 October 2023) unless otherwise agreed upon with the Mental Health Council of Tasmania*
I agree
I acknowledge that if I am successful in obtaining a grant it has been awarded on the merit of this application therefore if there are any changes to my event following submission of this application OR receipt of a MHW grant I will inform the Mental Health Council of Tasmania of these changes as a matter of priority*
I agree
I acknowledge that where there are significant changes to my event application the selection panel have the right to review allocation of grant funding based on those changes*
I agree
I acknowledge that the selection panel have the right to consider equitable distribution of funds across the state in their assessment of grant applications*
I agree
I acknowledge that the selection panel may offer partial funding and/or attach conditions to the allocation of grant funding*
I agree
I acknowledge that if my application is successful I will nominate ONE key contact from the event to liaise with the Mental Health Council in relation to event matters*
I agree
I acknowledge that if successful I will be required to provide evidence of appropriate acquittal of funding*
I agree
I acknowledge that if successful I will be required to evaluate my event and provide a summary of the evaluation to MHCT by no later than 20 November 2023*
I agree
I acknowledge that if successful in receiving a grant I MUST display the Mental Health Council of Tasmania logo and the State Government logo on promotional material and adhere to the Mental Health Week theme guidelines in the promotion of my event*
I agree
Submitting the Grant Application
By submitting your application, your organisation is agreeing to the following terms:

• Applications that are not authorised and submitted by a representative of their organisation will be deemed ineligible.
• Applications which are not successful will be notified via email and can be contacted for further information upon request.
• All applications will be assessed by a selection panel comprising of MHCT Media and Communications Manager, and other appropriate mental health sector representatives, which may include representatives from The Mental Health Drug and Alcohol Directorate and Primary Health Tasmania.
• Successful Grant recipient organisations will be notified and required to confirm acceptance of the grant. Once accepted by recipient, payment will be processed by MHCT by electronic funds transfer, to the account details provided in the application.

I agree to the above conditions of the application process and can assert that all information provided in this application is true and accurate at the time of submitting:
Name of Authorised Person*
Organisation/Group:*
Date:*
Date Format: DD slash MM slash YYYY
*Please be advised that MHCT will include all grant applicants on the MHCT mailing list to receive updates and information on Mental Health Week

Save and Continue Later

Item	Cost	Funding Source	Purpose

Just checking –do you, or someone you care about, need help with your mental health?

General Information

Your Mental Health Week Event

Other Information

Application Compliance and Checklist

Submitting the Grant Application