This Application is for communitieswho HAVE NOTpartnered with Right To Play in the past.NOTE: Before completing this application, it is essential that you read the Application Guide:

COMMUNITY INFORMATION

Name of First Nation, Urban Center or Organization:
Primary Contact: / Title:
Unit No./PO Box / Street No. / Street Name / Province
Telephone No. / Fax No. / E-mail Address

*Primary contact will be contacted if more information is required and will be the main contact throughout the application process. This should be someone who can be reached easily by phone and email between June 22nd and July 17th(while the interview/review process and subsequent agreement period) is underway.

COMMUNITY SUPPORT DETAILS

By signing below you are confirming that:

  • All of the information in this application is true to the best of your knowledge
  • Each signatory is in full support of and accountable to implementing a core PLAY program in the community and will promote itsdevelopment.

*NOTE: Applications from First Nations require a minimum ofthe Chief and two Council members’ signatures

Will the First Nation pass a Band Council Resolution in support of this initiative (If applicable)?
YES NO
Chief (First Nation)/Executive (Organization):
Council Member/Supporting Manager:
Council Member/Supporting Manager:
*Please attach more signatures if desired / Signature:
______
______
______
Education Authority Representative:
Elementary School Principal (if applicable):
High School Principal (if applicable): / Signature:
______
______
______
Recreation Coordinator (or equivalent): / Signature:
______

For Use By Right To Play

Reviewed By: / Date Received: (mm/dd/yy) / Notes:

PLAY is an intensive training and coaching program for local youth workers to help them design, initiate, facilitate, measure and celebrate truly powerful and dynamic outcome based programs that use sport and play as the vehicle.

This application describes what the PLAY program is designed to do and can help you to understand how the program can best support your community. If you have any questions or concerns about any of the listed questions, please don’t hesitate to contact Jasmin Glaw at or 416-203-0190 ext 355.

Please answer the following in the space provided belowand check the boxes where required.
If you need additional space, feel free to attach additional documentation.

COMMUNITY INTEREST AND IMPACT

  1. Please circle which PLAY program resources would be of most benefit to your community (please select all that apply):
-Program Manuals
-Community Mentor Trainings
-Summer Camp Trainings
-Sport For Development Clinics
-Coaching from a Program Officer
-Involvement in a Youth Leadership Symposium
-Program Funding
  1. Why do you want the PLAY program in your community? (500-800 words)
In your answer, you must tell us about:
What do you know about the PLAY program?
What are the strengths of and challenges for children and youth in your community?
Where do you want the children and youth in your community to be in 5 years, 20 years?
How can the PLAY program help you achieve your vision for the children and youth in your community?
(please be as specific as possible)
  1. Please use the space below to explain which of the four core PLAY programs (After School Program, Youth Leadership Program, Sport For Development Program OR PLAY for Prevention Program) you believe the communityNEEDS THE MOST AND WHY.We encourage you to seek these answers from youth and a variety of community members. (300-500 words)
NOTE: Urban centers currently are only eligible for the PLAY for Prevention Program
Refer to the PLAY program Overview if you are unsure of the program options.
GETTING TO KNOW YOUR COMMUNITY
The following questions are designed to help us get to know your community so that we can better understand your strengths and challenges. This will help us determine what the PLAY program could realistically look like in your community.
  1. Community Children and Youth
A)Approximately how many children/youth live on your reserve(if applicable)? ______
B)Tell us about the youth in your community. What kinds of activities and/or sports are they interested in?
  1. Community Members
A)How many people live on your reserve(if applicable)?______
B)Please place a check in the box if your community has a:
*Note: Not having one of the following facilities or resources will not affect the outcome of your application
Youth Council
Youth Worker(s)
Recreation Worker(s)
Please list any other human resources that can support youth in youth programs (i.e. Community policing, recreation workers, health workers etc.):
  1. Community Infrastructure
Please place a check in the box if your community has a:
*NOTE: Not having one of the following facilities or resources will not affect the outcome of your application
Youth Centre
Recreation Centre
Indoor ice hockey arena
Outdoor ice hockey rink
Elementary school
High school
Indoor recreation area that can be used as a gymnasium
Outdoor field that can be used for playing
Please list any other infrastructure/spacesthat could beused by youth for youth programs:
  1. Programs for Children and Youth
This section will tell us how PLAY could fit in with other programs in the community, and how PLAY could work together with existing programs to achieve positive outcomes for children,youth and the community as a whole.
A)Does your community currently offer any programs for children and youth?
(eg. hockey, lacrosse, basketball, soccer, arts programs, youth leadership programs, recreation programs, traditional dancing programs, drumming groups, music programs, drama programs, painting/drawing programs, etc)
YES NO
B)If yes, please complete the table below listing the types of programs your community runs (NOTE that if you want to list more than 7 programs, please use a separate paper):
Name of child/youth program / Approximate number of participants / Frequency and length of program (week/month/year) / Age of the participants / Organization responsible for running the program
1.
2.
3.
4.
5.
6.
7.
  1. Partnerships
The PLAY program is most successful in communities where local partnerships exist to support the overall delivery of the program.
A)Please list local groups and organizations that would be interested in supporting and collaborating with the PLAY program (i.e. Youth Council, Chief and Council, the elementary/ high school, Brighter Futures, Diabetes Initiative, etc)
*NOTE: Support for past programs has also taken many forms including refreshments, support staff, funding, etc.
B)How would these potential partnersbenefit/support the PLAY program?
STAFFING AND SUPPORT FOR THE PROGRAM
The success of the PLAY program is very dependent on the person who ishired to plan, lead and assess the program locally.The following questions will help us understand what kind of support your community could provide to the Community Mentor and to the program as a whole..
  1. In order to facilitate the program locally, Right To Play requires the First Nation, Urban Centre or Organization to hire a Community Mentor.
Community Mentor(s) –The role of the Community Mentor is to implement the PLAY program on a regular, weekly basis. Community Mentors are required to deliver a minimum of 8 hours of programming each week, in addition to time spent planning sessions and preparing monthly Monitoring & Evaluation and Financial reports.(NOTE: This minimum number of hours is an increase from previous years). Community Mentors also attend two mandatory week-long trainings each program year that take them outside of their community. For a more detailed explanation of the Community Mentor’s roles and responsibilities, please the Cooperation Agreement.
A)Your community is responsible for posting, recruiting and hiring the Community Mentor, and following community hiring policies and protocols. Are you able to do this?
YES NO
B)i) Is there someone in the community who has already been identified to take on the role of the Community Mentor if your community is selected for the PLAY program in 2015/2016?
YES NO
ii) If yes, please explain what makes this person a strong candidate. (250 words maximum)
iii) Is this person able and committed to leading a minimum of 8 hours of direct programming per
week with children/youth in the community?
YES NO
If no, please explain:
C)The first Community Mentor training is scheduled for September 21st to 25th, 2015. This means that a Community Mentor must be hired by September 1. Could you realistically have a Community Mentor hired by September 1, 2015?
YES NO
D)Please describe the current policy for CPIC and Criminal Reference checks for youth workers in your
community:
E)Each community who partners with Right To Play is required to submit the followingmonthly reports to a strict deadline:
•Detailed monthly Financial reporting
•Monthly program report
(Please see the PLAY Application Guide for further details)
Is this something the Community Mentor in your community will be able to do?
YES NO
F)i) Are there additional funds available to enable additional staff/part-time youth workers to offer support to the program?
YES NO
ii) If yes, please explain. (150 words maximum)
  1. In order to provide local support and guidance to the Community Mentor, each community must assign a Community Supervisor.
Community Supervisor – The role of the Community Supervisor is to offer support and supervision to Community Mentors on a day-to-day basis. The Community Supervisor should be someone who already has a salary within the community and who will be available to support and supervise the Community Mentor as part of their existing role.For a more detailed explanation of the Community Mentor’s roles and responsibilities, please see the Cooperation Agreement.
G)i) Is there someone in the community who has already been identified to take on the role of the Community Supervisor if your community is selected for the PLAY program in 2015/2016?
YES NO
ii) If yes, please explain. (250 words maximum)
H)i) Would the Community Mentor Supervisor be available to participate in phone calls with Right To Play on a regular basis to discuss the progress of the program or to communicate with Right To Play staff when necessary?
YES NO
ii) If no, please explain. (150 words maximum)
I)How would you expect the Community Supervisor and/or the communityto respond if the Community Mentor was not meeting their responsibilities or running a consistent program (ex. Not meeting financial, programming and/or monthly reporting requirements)? (250 words maximum)
FUNDING AND IN-KIND SUPPORT
  1. i) The Promoting Life-skills in Aboriginal Youth (PLAY) Program would not be possible without the important partnerships that have been formed with many visionary organizations.
We are grateful to the following organizations that fund PLAY. A complete list can be found here:

Are there any donors listed above that your community would not accept funding from?
YES NO
*NOTE: Not accepting funds from a particular donor will not impact the chance of receiving the program.
Rather, this information will help Right To Play determine how best to fund the program in your
community.
ii) If yes, please explain.
  1. What is the expected salary for someone in the position of local youth worker in your community?
  1. Right To Play expects the community to finance at least 50% of the Community Mentor’s salary. As such, Right To Play will cover salary costs for the first 6 months of the program year, and the partner community will cover salary costs for the latter part of the program year (beginning approximately March 1st, 2016). How much can your First Nation, Community or Organization contribute to the salary(ies)?Please list a dollar or percentage amount.
* NOTE: Communities that can fund 80-100% of the Community Mentor’s salary strengthen their chances of receiving the program
  1. In order for the Community Mentor to do their job effectively, they will need an office space and equipment (i.e. phone, computer, etc.). Will you able to provide these for the Community Mentorfree of charge? Where do you anticipate the Community Mentor will be working from?
  1. i) In order for the program to run regularly for children and youth, there needs to be a permanent complementary venue available for the program 3 to 5 times each week.An ideal venue should be large enough to safely accommodate 20+ children and include access to an indoor play space for sports and games.). Will your community be able to provide this free of charge?
YES NO
ii) Please describe the anticipated venue:
  1. i) Part of the PLAY program includes in-community support visits from Right To Play staff for 2-3 visits per year (approximately one week in length per visit). Will your community be able to provide an in-kind contribution of a safe, private space for Right To Play staff to stay during those visits?(e.g. hotel room, motel room, teacher’s accommodations, house, etc)
YES NO
ii) If yes, please describe:
  1. i) Has your community/organization already applied for funding for recreation, life-skill development or
youth leadership programs for 2015-2016?
YES NO
ii) If yes, what is the status of this funding?
ADDITIONAL COMMENTS
  1. Is there anything else the selection committee should know/ consider when reviewing your application?

All applications must be received byFriday June 19th, 2015by 5:00pm(local time) to:

Please send to Lauren Simeson

Sport For Development Manager, Promoting Life-skills in Aboriginal Youth (PLAY) program

Right To Play, Canada

65 Queen Street West, Suite 400, Box 64

Toronto, ON, Canada, M5H 2M5

Applications are also accepted by fax and email.

Fax: 1-416-203-0189

Email:

If you have any questions or comments about the application process, please contact:

Jasmin Glaw Tel: +1 (416) 203-0190 ext. 355, Email:

NEXT STEPS:

All communities will be contacted regarding their application by July 17th, 2015.

Thank you for your application!

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