Graduate Student Wellness Initiative Fund – Application

If you have any questions regarding this application, please contact gradwell@yorku.ca

Date: Date: / MM / DD YYYY

Student Name/Student Group:

Student Number:

Contact Email:

Contact Phone Number: Contact Phone Number: - ### - ### ####

Program Affiliation:

Name of the Initiative:

Initiative Description. Please provide a brief summary of your initiative including the objective, anticipated impact, timeline, and any other relevant details (350 words maximum):
Maximum of 350 words allowed. Currently Entered: 0 words.

Please describe how this initiative will contribute to awareness, promotion, and/or enhancement of graduate student mental health and/or well-being:

Please estimate the number of graduate student community members you expect could benefit from this initiative:

Please outline a recruitment strategy outlining how you will advertise your initiative to graduate students

Please describe how you plan to evaluate the impact/success of your initiative:

Will you be partnering with on or off-campus partners to implement your initiative? If so, please list and describe partner roles/contributions:

Amount Requested:

Detailed Budget:

Anticipated Initiative Start Date: Anticipated Initiative Start Date: / MM / DD YYYY

Anticipated Initiative End Date: Anticipated Initiative End Date: / MM / DD YYYY

Please attach any supporting documentation if applicable:

Attach Files

I/we agree to provide feedback regarding our initiative should we be successful in obtaining financial support through the Graduate Student Wellness Initiative Fund:

I/we agree to provide feedback regarding our initiative should we be successful in obtaining financial support through the Graduate Student Wellness Initiative Fund: Yes No