SUDI Prevention Grant Application Form Step 1 of 4 25% PhoneThis field is for validation purposes and should be left unchanged.Section One: Contact InformationOrganisation or group name(Required)Name(Required) First Last Enter the name of the key contact person for this application.Email(Required) Phone(Required)Tell us about the Group/Organisation.(Required) Section Two: Initiative / Activation SummaryActivation name(Required)Date of activation(Required)Time of activation(Required)Location of activity or initiative(Required) Street Address Address Line 2 City What outcome(s) are you aiming to achieve with this initiative? (Select all that apply.)(Required) Every sleep is a safe sleep Whānau have better knowledge about safe sleep practices that match their living situation Increased confidence in safe sleep practices among whānau Strengthened cultural connections through mātauranga Māori approaches Increased awareness of the importance of breastfeeding in protecting infant health More whānau creating smokefree environments Whānau feeling more supported and connected through this kaupapa Other Please add other outcome here(Required)How will your activation support these outcomes? (Provide details about your kaupapa and planned activities.)(Required)Key Messaging All funded initiatives must promote these key safe sleep messages: Place baby on their back for every sleep Ensure baby’s face is always up and clear Breastfeeding provides protection against illness Use gentle hands when holding and caring for baby Smoking and vaping when pregnant increases the risk of SUDI. How will you raise awareness around safe sleep messaging?(Required)How will your kaupapa promote these messages to whānau? (Provide details on how these messages will be incorporated.)(Required)Who is your target audience?(Required) Hāpu Māmā and their whānau Mainly Dads Teen Parents All Whānau Other Please add other target audiences here:(Required)How does your event engage your target audience? (Explain how you will reach and involve them.)(Required)Are you collaborating or working with another group or individual to deliver this activation? How are they contributing?(Required)How many people do you expect to reach through your activation?(Required)Please enter a number greater than or equal to 0. Section Three: Budget Please outline how you plan to allocate your grant funding.Detail each item and its cost. (i.e. marquee hirage - $300) Remember: The grant covers costs directly associated with delivering your activity, up to $5,000. Eligible expenses include: Venue or equipment hire Support for volunteers Equipment Costs associated with promoting your activity Medals, prizes, giveaways, and spot prizes Funding does not cover: Costs not directly required for the activity (e.g., salaries or wages for existing staff, administrative costs or management expenses). Capital costs (e.g., facility development and maintenance, resources which are used to generate income in the future). Fill in as many items as needed in your budget.Item 1(Required)Cost(Required)Please enter a number greater than or equal to 0.Item 2CostPlease enter a number greater than or equal to 0.Item 3CostPlease enter a number greater than or equal to 0.Item 4CostPlease enter a number greater than or equal to 0.Item 5CostPlease enter a number greater than or equal to 0.Item 6CostPlease enter a number greater than or equal to 0.Item 7CostPlease enter a number greater than or equal to 0.Item 8CostPlease enter a number greater than or equal to 0.Item 9CostPlease enter a number greater than or equal to 0.Item 10CostPlease enter a number greater than or equal to 0.Item 11CostPlease enter a number greater than or equal to 0.Item 12CostPlease enter a number greater than or equal to 0.Total Section Four: Trust information Consent(Required) I confirm that I am authorised to submit this application on behalf of the organisation, and that our directors and/or trustees and/or treasurer are aware of and support this submission.(Required)Consent(Required) I declare that we/the organisation in application do not receive funding from Health New Zealand Te Whatu Ora – SUDI Prevention.(Required)Reporting(Required) I have read and agree to the Terms and Conditions.(Required)Read here: Terms and ConditionsUpload any supporting documentation Drop files here or Select files Max. file size: 150 MB. Upload any supporting documentation that is relevant to this application.
