Application Form

Strengthening Early Intervention - Suicide Prevention Grants

Western NSW Primary Health Network (WNSW PHN) is delivering the “Strengthening Early Intervention” Suicide Prevention Grants Program to support community‑based, non‑clinical activities that help recognise distress earlier, strengthen local support pathways, and promote wellbeing across the Western NSW region.

Many communities across Western NSW experience barriers to accessing timely, culturally responsive, and place‑based supports for people experiencing distress, particularly outside traditional clinical or health service settings. Community organisations, local groups, and informal networks are often the first to notice early signs of distress and can play a key role in providing early support and connection before issues escalate.

This program provides one‑off grants to enable communities to deliver practical activities that respond to local needs, complement existing services, and strengthen protective factors such as connection, belonging, cultural identity, and wellbeing.

Applicants are required to read the Grant Guidelines before applying. Submission of a signed online application does not guarantee funding. WNSW PHN reserves the right to request changes to the proposed activity prior to approval.

Funding of up to $15,000 (excluding GST) is available per eligible organisation. All funded activities must be completed by 30 June 2027

Applications will remain open until funds exhausted.

APPLICATION DETAILS

Legal Name of Organisation: *

Trading Name of Applicant (if applicable):

Do you have an ABN? *

Yes No

ABN: *

Are you registered for GST? *

YesNo

If Other, please specify *

Street address *Street address line 2

City *

State *

Postcode *

Briefly describe your organisation (no more than one paragraph) *

APPLICATION CONTACT DETAILS

In this section you are asked to provide contact details of your organisation's authorising officer and/or key contact person for this application. The authorised contact person is the person who is authorised to sign a funding agreement on behalf of your organisation, should your application be successful.

Authorised Person’s name: *

Authorised Person's Position title: *

Authorised Person's Email Address *

Authorised Person's Phone number *

The application contact should be the person we will contact for any issues related to the application and project activity:

Application contact person: *

Application contact person position title: *

Contact Person's Email Address *

Contact Person's Phone number: *

ELIGIBILITY CRITERIA

To be eligible for funding, applicants must: *

Demonstrate a local presence and/or active service delivery footprint within the Western NSW PHN region.

Be one of the following *

Registered not‑for‑profit organisation, charity, or incorporated community organisation.Aboriginal Community Controlled Organisation (ACCHO) or Aboriginal‑led organisation.Local government entity, school, or education provider proposing a community‑based suicide prevention or wellbeing activity.Youth, cultural, sporting, or community group that is incorporated or auspice by an eligible organisation for the purposes of managing grant funds.

Holds Public Liability Insurance (minimum coverage $10 million) *

YesNo

Details of Proposed Activities

1.Explain how your proposed activities align with the program objectives outlined in Section 3 of the Grant Guidelines. - Weight: 30% (Word limit - 300) *

2. Describe your organisation’s experience and capability to deliver this project, including any relevant past projects. - Weight: 20% (word limit - 250) *

3. Where relevant, describe any partnerships that will support project delivery and outcomes - Weight: 20% (word limit 250) *

4. Describe any relevant cultural capability, training, or partnerships that support your approach - Weight: 20% (word limit 250) *

5.Confirm how the project will be delivered within the $15,000 grant funding - Weight: 10% (word limit 200) *

ACTIVITY BUDGET

Please provide a breakdown on how you intend to utilise the funds.

Expense Type *

Description of expenses *

Budgeted Amount (excl GST) *

Total Amount Budgeted $ (excl GST) *

DECLARATION

This section must be completed by an authorised representative of the organisation submitting the application.

I declare that:

I confirm the contents of this application are to the best of my knowledge accurate, complete and do not contain any false, misleading, or deceptive misrepresentation, claims or statements. *

I have read, understood, and agree to the Grant Guidelines, should this application be successful. *

I declare that the organisation is financially viable and able to manage the funding within the timeframe and within budget. *

I understand that the evaluation decision is final, and no correspondence will be entered into. *

I understand and accept that information provided in this application will be stored by WNSW PHN in various formats, including hard copy and or electronic. *

I confirm that this application does not duplicate existing funding, service delivery or ongoing operational costs. *

I agree to contact WNSW PHN should I become aware of any changes to information contained in this application. *

I understand that this application does not create a legal or binding commitment. *

If the application is successful, I acknowledge that:
- The organisation will be asked to sign a Grant Agreement with the WNSW PHN;
- The organisation will be asked to sign a statement stating they have used the funds in accordance with their application;
- The organisation will provide reports to the WNSW PHN in accordance with their grant agreement; and
- The organisation agrees to maintain adequate insurance for the duration of this grant agreement and provide WNSW PHN with proof when requested. *

I understand if the conditions of the funding are not complied with:
- The WNSW PHN will recover the funds allocated; and
- The WNSW PHN may terminate the grant agreement with the applicant. *

I have read the WNSW PHN General Grant Conditions *

Applicant Signature *

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Please complete the CAPTCHA challenge below to verify that this submission is being made by a human applicant. * *

Name *

Position *

Date: *

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