Positive Memory Bank - Berry Street

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Appendix 4: Case Study – Zara Page | 27
Appendix 5: Application Form Date received: Reference #: Program Area: Region: Funding Category: Up to $500 $500-$1,000 Submitted?: GG Mtg date: Attachments: For Office Use Only Positive Memory Bank Application Form If this is a GROUP APPLICATION please complete the Group Application Cover Sheet and skip the first box of questions on this page. Name: _____________________________________________________________________________ Date of Birth: _____/_____/_____ Age: ________________________________ Gender: M / F Your Contact Phone: ________________________ Which Berry Street program or service are you connected to? ___________________________________________________________________________________ Which Berry Street Region are you in? Hume Northern Southern Gippsland Do you identify with a culture other than anglo-Australian? Yes No If yes, which culture do you identify with? Who is the worker supporting your application? (Please give us their full name and job title) ___________________________________________________________________________________ ___________________________________________________________________________________ How much money are you asking for? $______________ When do you need the money by? (When does the activity/opportunity need to be paid for?) ___________________________________________________________________________________ We would like to know a bit about what you want to use this money for. You can give us your answers in writing or you can draw a picture, attach a photograph or make a poster or a collage to explain your ideas/opinions. Please feel free to attach more bits of paper if there isn’t enough space on this form – make sure you put your name/names on anything you attach! Have you attached: Berry Street staff member support letter? Signed privacy form? Any extra drawings, photos etc to support your application? Would you be interested to take part in the Giving Group, helping to decide where this money goes in the future? Yes No If you would like more information about what this means, please contact Lauren Oliver on 9421 7535 or loliver@berrystreet.org.au. Page | 28
Page 1 and 2: Positive Memory Bank Pilot Evaluati
Page 3 and 4: Contents Acknowledgements ………
Page 5 and 6: empower their clients to decide wha
Page 7 and 8: inevitably resulted in negative fee
Page 9 and 10: 4. Improve the model for monitoring
Page 11 and 12: 1. Introduction Berry Street believ
Page 13 and 14: 2. Outcomes Three full case studies
Page 15 and 16: 2.4 Berry Street Culture Anecdotal
Page 17 and 18: The table below demonstrates the ga
Page 19 and 20: drawings, photographs and DVD’s.
Page 21 and 22: perspective and chance for the Givi
Page 23 and 24: 7. Conclusions In addition to provi
Page 25 and 26: Female, 15yrs Group Male, 12yrs Fem
Page 27: Appendix 3: Case Study - Ben Page |
Page 31 and 32: If you are successful in getting mo
Page 33 and 34: Is there anything else you would li
Page 35 and 36: Application Evaluation How did you
Page 37 and 38: Who can apply for funds? Applicatio
Page 39: Such as? Please describe: How satis

Positive Memory Bank - Berry Street

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