Student Mental Health and Wellness Grant – Individual Application Form

Please complete all sections

The NSTU Group Insurance Trustees will support projects up to $600 depending on the number of applications. The next applications will be due on/or before 11:59 pm on October 15th.

Name

Project Name

Email Address

Professional #

Employment Status

School Address

School

NSTU Local

School Phone

Home Phone

Time Frame of Project

Start Date

Completion Date

Project Description
This description is used to assist in the review process and to outline successful projects on the NSTU website. Please provide a detailed outline of your project including details of the project, the implementation plan, the value of the project to your school or community and how you will note if the project is successful.

Project Description

Amount of Funding Requested (recommended limit up to $600.00)

Expenses

Services / Consumables / Equipment / Other

The Student Mental Health and Wellness Grant may approve services, workshop expenses, rentals and labour fees, “consumables” such as paint, paper, certificates, etc., equipment, capital items or other, when they are required to support implementation of the project. (Please itemize in detail below.)

Description(s)

Cost(s)

Total Expenditure

If full amount is unavailable, will the project be abandoned or modified?

If modified, explain how

Has the project received funding by the Student Mental Health and Wellness Grant in the past three (3) years?

Person to be responsible for disbursement of funds/receipts

Person(s) with signing authority

Other Sources of Income

List any other sources of income.

Total Other Income

Please note, all out of pocket expenses related to the application and subsequent project, will be incurred by the member. Expenses will only be reimbursed upon completion of the project based on the noted completion date and should include a formal summary report with all disbursements and receipts. All projects must be completed prior to the end of the current school year. Please acknowledge that you have completed the above application understand all rules / requirements as it pertains to the Student Mental Health and Wellness Grant by clicking the box.

Yes

Please acknowledge that you have reviewed the Student Mental Health and Wellness Grant Rubric that will be used to evaluate your project.

Yes

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