(VCH/VCMHS)CONSUMER INITIATIVE FUND

EDUCATION AND LEISURE FUND AVAILABILITY

CRITERIA FOR APPLYING: Please Read Carefully!

· Must be an identified consumer of mental health services in low income bracket who lives in Vancouver

· Monies paid only to educational institute. No reimbursements available. This includes courses already begun.

· Cannot have received funding in the last two years

· Can take only one course with a limit of up to $400.00. Applicants are responsible for any and all costs over this amount.

· IF you receive a receipt after taking your course, you must send it to our office. Failure to do so will result in your not receiving funding in the future.

· Must include a brief letter of intent and/or a brief letter of support indicating your desire/ability/suitability to take and complete the course

· If you feel it necessary to include your Mental Health worker in the application process, please acquire a letter from him or her stating this

· Must be willing to respond to a follow-up evaluation upon completion of the course

· Have own phone number and be able to return a message within 48 hours

· Registration is the funded student’s responsibility

****NO REIMBURSEMENTS****

Application Open Oct.20-Nov.10/08 for Winter/09 Disbursement

Completed applications are considered on a multiple lottery draw basis – the earlier the application is received, the more draws it will be included in!!!!

We regret we cannot fund supplies or textbooks

APPLICATION FORMS SHOULD BE AVAILABLE AT ALL TEAMS/UNITS/AGENCIES POSTING THIS NOTICE. THEY ARE ALSO AVAILABLE AT RECEPTION DESK, CENTRAL OFFICE, #200 – 520 W. 6th Ave

(VCH/VCMHS) CONSUMER INITIATIVE FUND EDUCATION AND LEISURE FUND APPLICATION

If you receive services for mental health and are thinking of taking courses to enhance your life or to improve your skills, financial aid is available.

PLEASE READ CAREFULLY

Fax or deliver this COMPLETED application form to the CIF Committee office at #200 – 520 West 6th Ave., Vancouver, B.C. V5Z 4H5 (604-708-5317 Ext. 2) as soon as possible, to increase your chance at this opportunity. Be in as many draws as possible! Deadline is November 10,2008 (ForWinter 2009 courses) FAX: 604-874-7661

Your name:______________________________________________________________

PLEASE PRINT CLEARLY

Address (must include postal code):__________________________________________

Phone Number: (must have message service available)____________________________

Date of Birth:___________________Social Insurance #:__________________________

Date/Month/Year

· Address of School or Institute (include postal code):

________________________________________________________________________

· Phone of school or institution: __________________________________________

· Name and Number of Course:__________________________________________

· Tuition Fee & Tax: _____________If over $400.00, YES_____ I can pay the difference.

· Starting Date: _________________________Completion Date:___________

Have you accessed these funds before? YES _____ NO _____ If yes, we regret you are only eligible after two years have passed

How did you find out about this fund? _______________________________________

We regret that we do NOT fund books or materials

NO REIMBURSEMENTS

We fund up to $400.00 for only ONE course

Please attach your letter of intent and/or letter of support to this Application