Claudette Bradshaw Innovation Award application form

Application Deadline: August 21, 2023 - applications due by 4:30PM PDT

Award recipient will be notified by: End of September 2023

See the CanFASD Claudette Bradshaw FASD Innovation Award Application Guidelines for more information on eligibility and application requirements.

Section 1 - Applicant Information

Name *

First

Last

Lead contact

First

Last

Provide the name of the lead contact if different from than the applicant.

Organization *

Title or Position *

Organization Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Primary Email *

Email

Confirm Email

Alternate Email

Email

Confirm Email

Add second contact

Check to add another project contact

Name

First

Last

Title or Position

Email

Confirm Email

Checkbox for third contact

Check to add another project contact

Name

First

Last

Title or Position

Email

Confirm Email

Section 2 (optional) – Researcher or Evaluator Information

If the applicant partnered with an external researcher or evaluator to assess the program, please complete this section. It may otherwise be left blank.

Name

First

Last

University/department or organization

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Email

Confirm Email

Section 3 – Overview of Agency/Organization (200 words max)

Please provide a brief overview of your agency or organization (additional details about the specific program/service for which you are applying will be requested below). If you collaborated with a researcher or evaluator, please include a short description of the research/evaluation purpose.

Enter Agency/Organization description (200-word max) *

Section 4 – Statement of Impact (300-word max)

In this section, please describe why you are interested in applying for the Claudette Bradshaw FASD Innovation Award and how this award would impact your organization or program/service.

Statement of Impact (300-word max) *

Section 5 – Overview of Program/Service

Program title/name *

Location - Town/City *

Location - Province/Territory *

Area of Support *

State the area(s) of support that your program/service addresses (e.g., housing, employment, parenting, substance use, justice, child welfare, education, mental health, etc. List all that apply.

Section 6 – Details of Program/Service

Please provide a general description of your program/service *

In what way(s) is your program/service designed to support youth and/or young adults with FASD? *

How do you know your program is making a difference? *

In what ways is your program/service innovative or novel? *

How do you use research and/or best practice evidence to inform your program/service? *

What knowledge translation resources or publications have you developed from your program/service? If you have not yet developed resources or publications, please describe what you plan to develop in the future. *

Section 7 – Memorandum of Understanding, Letter of Support

Where did you first hear about the award (select all that apply): *

If Other:

Letter of Support

A Letter of Support must be submitted from a participant/client of the program/service, e-mailed to info@canfasd.ca, with the lead applicant name in the subject line. The letter should describe their experience in the program/service and how the program/service benefitted the individual. The letter should not include the name of the individual and be no longer than 1 page.

Claudette Bradshaw Innovation in FASD Award Memorandum

Applicants must agree to the Award Memorandum before submitting the application. Upon approval, CanFASD shall notify the recipient and forward funds to them via electronic money transfer (EFT) or mailed cheque.

The information above, including the title of the project, description of research project, name of applicant, name of the Agency or group and involved parties may be posted on the CanFASD website and may be used by CanFASD to publicize the Claudette Bradshaw Innovation in FASD Award.

Award Memorandum *

Participants listed above have agreed to the terms of the Claudette Bradshaw Innovation in FASD Award, as outlined in the application and in the Award Criteria. Upon approval, CanFASD shall notify the recipient and forward funds to them via electronic money transfer (EFT) or mailed cheque.