Integrated Health Awards 2008 application form

Part 1: Contact details

Project name

Project address

Main contact person

Contact telephone number

Contact email address

Project website

PART 2: Project Information

Please tell us what your project does using no more than 50 words

Year established

Number of paid staff (full time equivalent)

Number of volunteers

Number of users per year

Part 3: Meeting the criteria

1) We believe that we should be an Integrated Health Award winner because…….(500 words max)

2) Describe a typical user’s journey through your project from start to finish (300 words, your answer should address criteria 1, 2, 4, 5, 6)

3) Demonstrate the impact of your project on service users. (300 words, your answer should address criteria 2, 4, 5, 6 and 9)

4) Demonstrate how you audit and evaluate your project to ensure that it meets the needs of users. (300 words, your answer should address criteria 4 and 8)

5) How do you ensure that your project is accessible to as many users as possible? (300 words, your answer should address criteria 4 and 9)

6) Demonstrate how you have built and sustained relationships in your community. (300 words, your answer should address criteria 7)

7) What processes would others need to follow in order to replicate your project model elsewhere? (300 words, please talk about financial sustainability, leadership and the requirement of the service, your answer should address criteria 3)

8) Outline the governance and management structure of your project and how you support and nurture staff. (200 words, your answer should address criteria 10)