Apply - Hāpai Grants

Applicant name(Required)

Enter the key contact name for this activation.

First Last

Organisation or group name(Required)

Email(Required)

Phone(Required)

Name of Activation(Required)

Activation Summary(Required)

The intention of this activation grant is to support community-led initiatives that provide a direct pathway for whānau to quit smoking. Please provide as much detail as possible when completing this form. The more detail you provide, the easier it is for us to understand how your initiative will support whānau to become smokefree.

How will this activation be delivered?(Required)

E.g. series of workshop, wananga etc.

Please provide the dates and duration of each session you plan to deliver(Required)

If your activation is run over a number of days, please tell us your start date and all the dates you intend to deliver the kaupapa. And how long each session will run for

Location of the activation(Required)

Street Address Address Line 2 City Region

How will you ensure whānau who smoke will attend your activation?(Required)

How will your activation connect whānau with quit support?(Required)

Have you as an individual or a group been the recipient of a community activation grant before?(Required)

Yes

Have you attempted to contact your local stop smoking service? And will they be present at your activation?(Required)

Who are you collaborating/working with to deliver this activation and how are they contributing?(Required)

E.g. Resources/Funding/In-person Delivery

How many people are you expecting to directly engage with through this activation?(Required)

Please enter a number from 0 to 100000.

How will you continue to mobilise the Smokefree messaging in your community after the activation has ended?(Required)

Do you wish to request the use of SF/Hāpai event equipment? (Equipment is subject to availability.)

By selecting any of the equipment below you agree to the below terms.

Gazebo

Flag banners

Pull up banner

Terms for equipment requests

We kindly ask that while you are in possession of the resources provided you ensure that these items are kept in good condition and used only for their intended purpose. Any damage, loss, or misuse of the resources will be the responsibility of the recipient, and you may be required to cover the cost of repairs or replacement.

Smokefree Community Activation Grant

Budget worksheet

Declaration

Email

Phone