Application for Grant Funding

Step 1 of 2

Requesting Agency: *

Project Name: *

Funding Request: *

Total Cost of Project/Program: *

Brief Description of Project: *

(Please be specific. Limit 500 words)

Name of Organization: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Fax

Email *

Project Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Person: *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Fax

Website / URL

1. Describe how your project addresses the need for increase in bed capacity and how many beds will be added. [Limit 300 words]

2. What steps or activities or funds need to be taken/provided prior to the implementation of this project? [Limit 300 words] *

3. At the completion of this project, what further steps or activities or funds need to be taken/provided to fulfill the goal of increasing bed capacity? [Limit 300 words] *

4. Provide local data/information that demonstrates the need for this recovery residence bed expansion in your community. [Limit 400 words] *

5. Describe actions/activities/services to be provided and timeline for implementation. [Limit 300 words] *

6. Describe how you will evaluate the project/program. [Limit 300 words] *

7. What other community partners/agencies are sharing or will share in the responsibility of the project or providing any in-kind contributions (please include letter(s) of support, if available)? *

Upload Letter of Support, if available

Click or drag files to this area to upload. You can upload up to 3 files.

8. Upload completed Budget Justification Form. Download form below.

Click or drag files to this area to upload. You can upload up to 3 files.

Download Budget Justification form here

9. What is the total cost of the comprehensive project/program, if these funds do not complete project/program? *

10. Please attach documentation reflecting current DMHA Certification as level II, III, or IV Recovery Residence.

Click or drag a file to this area to upload.

11. Please attach documentation of IRS Designation as Not-For Profit organization (if applicable).

Click or drag a file to this area to upload.

12. Please upload a copy of your company's Tobacco-Free Policy.

Click or drag a file to this area to upload.

Please upload a copy of a completed W-9.

Implementing Agency Signatures

We, the undersigned, have read and agree to comply with the aforementioned terms, conditions, requirements, and deadlines. We realize that failure to do so may result in the denial of future funding requests.

Name of Applicant (Organization) *

Date *

Director of Agency *

Signature *

Clear Signature

Please contact Kat Stuart, INARR Recovery Residence Support Manager via email at kstuart@mhai.net with any questions or concerns.

INARR Code of Ethics

Assess each potential resident’s needs and determine whether the level of support available within the residence is appropriate; Provide assistance to the resident for referral in or outside of the residence.
Value diversity and non-discrimination.
Provide a safe, homelike environment that meets NARR Standards.
Maintain an alcohol- and illicit-drug-free environment.
Honor individuals’ rights to choose their recovery paths within the parameters defined by the residence organization.
Protect the privacy and personal rights of each resident.
Provide consistent and uniformly applied rules.
Provide for the health, safety and welfare of each resident.
Address each resident fairly in all situations.
Encourage residents to sustain relationships with professionals, recovery support service providers and allies.
Take appropriate action to stop intimidation, bullying, sexual harassment and/or otherwise threatening behavior of residents, staff and visitors within the residence.
Take appropriate action to stop retribution, intimidation, or any negative consequences that could occur as the result of a grievance or complaint.
Provide consistent, fair practices for drug testing that promote the residents’ recovery and the health and safety of the recovery environment and protect the privacy of resident information to the extent allowed by law.
Provide an environment in which each resident’s recovery needs are the primary factors in all decision making.
Promote the residence with marketing or advertising that is supported by accurate, open and honest claims.
Decline taking an active role in the recovery plans of relatives, close friends, and/or business acquaintances who may apply to live in the recovery residence.
Sustain transparency in operational and financial decisions.
Maintain clear personal and professional boundaries.
Operate within the residence’s scope of service and within professional training and credentials.
Maintain an environment that promotes the peace and safety of the surrounding neighborhood and the community at large.

The Code of Ethics must be read and signed by all those associated with the operation of the recovery residence. All persons in position of authority within the home are assumed to be familiar with this Code of Ethics and are required to adhere to its terms. This statement commits the signatory and all responsible persons to adhere to this Code and to maintain a vital concern for the lives and well-being of all residents, staff, volunteers and family members. Individuals subject to this code are obligated to report unethical practices according to the reporting rules set forth by the affiliate. In signing the following, I affirm that I have read, understand and agree to abide by this Code of Ethics.

Your Name: *

Signature *

Clear Signature

Title: *

Organization: *

Date: *