Ministry of Community and Social Services (MCSS) for Family Support Networks, March 2018 Application Form Please read the Guidelines for Completing the Ministry of Community and Social Services Application Form for for Family Support Networks, March 2018 before completing this application. The Guidelines contain important information to help you complete your application. If you need assistance with completing this application or alternative accommodations with the Guidelines, please email MCSS.FSN@ontario.ca or call 416-325-4197. Applicants must submit their completed application form to MCSS.FSN@ontario.ca or to Allison DaCosta, Community Supports Policy Branch, Ministry of Community and Social Services, 80 Grosvenor Street, 4 th floor, Hepburn Block, Toronto, Ontario M7A 1E9 no later than 11:59pm on Monday, April 16, 2018. Once you have completed the form electronically and saved it, click on Submit Form at the end of the application to submit the document. Part 1: Applicant Contact Information Family Support Network or Organization Name: Mailing Address: City: Province: Postal Code: Website: Email: Applicant Information (Family Support Network or Organization Contact Information for MCSS) Name: Phone Number: Email: Can MCSS share your contact information with Developmental Services Ontario so that they may create a contact list? Queen's Printer for Ontario, 2018.
Part 2: Family Support Network/Organization Information Please refer to the definitions of a Family Support Network and organization in the Guidelines before completing this application. You are applying as (check one): Family Support Network An organization that supports Family Support Networks What year was your Family Support Network or organization created? Does your Family Support Network or organization have a membership list? Please briefly describe the purpose and work of your Family Support Network or organization. If you are applying as a Family Support Network, please answer below. If not, leave blank. How many families are connected to your Family Support Network? How many non-family, unpaid caregivers are connected to your Family Support Network? Does your Family Support Network include members who 1) have family members over the age of 18 who have a developmental disability and/or 2) provide unpaid caregiving to people with a developmental disability who are over the age of 18? If yes to the above, how many members meet this description? 2
If you are applying as an organization, please answer below. If not, leave blank. How many Family Support Networks does your organization support? Do the Family Support Networks your organization supports include members who 1) have family members over the age of 18 who have a developmental disability and/or 2) provide caregiving to people with a developmental disability who are over the age of 18? Part 3: Project Description/ Requested In this section, tell us about your proposed items/activities and the funding for 2018/19. Review the Guidelines for a list of ineligible expenses and examples for completing this section. For each item/activity, provide a description, describe the benefit to your Family Support Network or organization, identify which of eligible expenses applies and include the cost. As noted in the Guidelines, the categories of eligible expenses include those that: 1. Enhance engagement of members. 2. Promote communications and information-sharing among members. 3. Provide administrative support to the Family Support Network or organization. A fee of up to 10% of expenses charged by a transfer payment agency to a selected Family Support Network or organization for the purpose of administering approved funds related to this Call for Applications is considered an eligible expense (items/activities) that will be funded by MCSS under this funding. It does not need to be included as a separate line item. The final fee that will be funded by MCSS for selected applicants will be based on the actual expense charged to the Family Support Network or organization by the transfer payment agency. Table 1: Requested a) Identify and describe your item/activity including how the funding will be used in 2018/19. Describe the benefit of the item/activity to your Family Support Network or organization in 2018/19. (Specify one item/activity per row; add additional rows or pages as necessary) 3
Table 1: Requested a) Identify and describe your item/activity including how the funding will be used in 2018/19. Describe the benefit of the item/activity to your Family Support Network or organization in 2018/19. (Specify one item/activity per row; add additional rows or pages as necessary) 1.a) 2.a) 4
Table 1: Requested 3.a) 4.a) 5
Table 1: Requested 5.a) 6.a) Total Requested $ 6
Part 4: Additional Information (Optional) In this section, feel free to provide us with more information if there is something else you would like MCSS to know that is not already covered in the application. Do you have anything to add that might be important for MCSS to consider with respect to this application? Applicants must submit their completed application form to MCSS.FSN@ontario.ca or to Allison DaCosta, Community Supports Policy Branch, Ministry of Community and Social Services, 80 Grosvenor Street, 4 th floor, Hepburn Block, Toronto, Ontario M7A 1E9. 7