Wellness Fund Application Package

Deadline for Application Submission: November 1st by midnight

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Table of ContentsApplication Package

Page

Application Criteria 3

Application Form 5

Social Determinants of Health 10

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APPLICATION CRITERIA

The intention of the Wellness Fund is to support community-defined priorities through grants

made to community groups and organizations. Priority for funding will be based on

community projects that address one or more of the priorities identified in the community

health plan of each Community Health Board (CHB) to which you are applying. Other projects

that will impact on the Social Determinants of Health (attached) will also be considered by the

CHB.

1. The projects applying for CHB Wellness Funds must not:

Fund programs that diagnose, treat or rehabilitate health problems.

Fund operational purposes by the Nova Scotia Health Authority (NSHA) or CHBs.

Publicly funded groups and organizations will be considered if they can demonstrate

need and community involvement in project planning and evaluation;

Duplicate existing community services or programs (may build upon existing services);

Fund a period of longer than 12 months;

Be an individual, for-profit organization or Government Departments or Agencies, e.g.,

Dept of Education (school boards are non-profit and can apply), or Municipalities

(community-led partnerships with towns can apply); or

Be solely for the purpose of fundraising.

2. Wellness Funds are provided for non-profit groups and organizations that have been

together a minimum of six months and are able to receive, manage, and track funding.

3. Funding can support existing activities and projects; however, organizations that receive

funding in one year cannot be guaranteed continuous funding in successive years.

4. Equipment or furniture that will outlive the life of the project may be purchased, at the

discretion of the CHB and NSHA, provided the requesting group can show that the item is

essential to the program and that if the program cannot be sustained that said equipment

can be transferred to another like organization to sustain the use of said equipment.

5. It is the responsibility of the organization or individual receiving the grant to ensure that all

Provincial and Federal regulations are adhered to.  This includes the requirements of

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Revenue Canada that a T4 or T4A is issued to all personnel being hired with an hourly

wage, or hired by contract of more than $500.  The organization or individual receiving the

grant should contact Revenue Canada to determine what is required to adhere to such

regulations. 

6. To ensure the funding will be spent as laid out in the application plan, reports, receipts and

a budget summary must be submitted to the CHB. Mid-Term Interviews may be conducted

with a CHB member. Final Reports must be received within 60 days of project completion.

Failure to submit reports will impact future funding application. In some cases, the NSHA

may conduct an audit of how funds were used should a final report not be received.

7. Each funding request from a community group or working group may be approved for some

or all of the funding being requested. Grants will typically be funded in amounts of under

$3000. Requests greater than this amount may be considered on a case-by-case basis.

8. Applicants are strongly encouraged to seek financial support from multiple funders. Given

the limited funding available, projects that demonstrate existing or potential funding

partners will be considered more viable.

9. Applicants may be expected to present to the CHB and sign contracts before funding is

disbursed. (Exceptions may be given in unusual circumstances).

Before submitting your proposal, you are encouraged to contact your local CHB to discuss your project to ensure it meets the criteria outlined above. Deadline for submissions is November 1 st by midnight.

Please send completed applications to:

Monique Mullins-Roberts – Coordinator Southeastern Community Health BoardRm 545, Belmont House 33 Alderney Drive, Dartmouth, NS. B2Y 2N4902-460-6869Monique.mullins-roberts@nshealth.ca

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Wellness FundApplication Form

Contact information

Organization Name:

*For processing cheques – the organization should have a bank account in its name.If the cheque should be issued in another name, please indicate here:

Project Title:

Contact Person/Title:

Address:

Phone:

Email:

About Your OrganizationType of Organization (Check all that apply):

Not for Profit

Local or community-based group

Charity

Publicly-funded organization

Other – specify:

Project Start Date: Project End Date:

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For Office Use Only:

Date received by office:_____________ Amount of funding requested :______________________

If funding has been allocated in the past, Final Reports(s) have been received:_______________ (Y/N)

Final Report Due: ______________________________

About Your Project

1. Please provide a brief overview of your organization and your areas of focus.

2. Please provide a description of your project (including goals and outcomes )

3. Who will participate in the development and implementation of the project? (Please list specific partners)

4. Who is the target group (population served) and how have they been involved in the planning of the project?

5. Where will your project take place? (be specific)

6. Which CHB health plan priority areas or Social Determinants of Health will this project address?

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7. Please list all sources of funding. Have you applied for funding from any other CHBs? If yes, please specify which CHB and the amount requested.

8. What do you expect will be the greatest change or long term benefit of this project? How will you measure this change?

9. Will your project continue after the funding period? How is your project sustainable?

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Finances

Please provide budget details for your project. Include the total cost for the project and the amount requested from the Community Health Board Wellness Fund.

Item Brief Description of TotalWages/Honorarium/Travel Costs (for facilitators, staff, speakers, etc.)Materials and Supplies (e.g., printing, copying, miscellaneous supplies) Advertising and Promotion

Participant Support (child care, transportation, interpreters, etc.)

Food/Refreshments

Facility/Room Rental

Equipment Rental/Purchase

Other items

TOTAL PROJECT BUDGET $ TOTAL Funds Requested from Wellness FundsFunds from Other Sources

In-Kind Donations(estimated value of donations)

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If your project is funded you will need to:

Sign and agree to be responsible for the money;

Agree to a Mid-Term Interview, if applicable, and send in a completed Final Report

(copies of receipts must be sent with these reports);

Agree to use the money in the manner outlined in your application;

Agree that the CHB and/or NSHA have the right to audit the grants;

Agree that the CHB/NSHA/DHW (Department of Health and Wellness) may use

information about the recipients of these grants in press releases and for advertising

purposes; and

Agree to acknowledge the CHB in any promotion of the project.

Signature of Applicant: **Please note that signatures are not required if sending application via

email. The email will be kept on file for verification purposes.

________________________________ ___________________________________Signature of Applicant Date

How did you hear about CHB Wellness Funds?

Newspaper Ad _____

Press Release _____

Provincial CHB Website _____

Poster/Brochure _____

Email _____

Word of mouth _____

Social Media _____

Other ________________________

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