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2020/2021 CIVIL FORFEITURE CRIME PREVENTION AND
REMEDIATION GRANT PROGRAM
APPLICATION FORM
STREAM: DOMESTIC VIOLENCE PREVENTION/INTERVENTION
PROGRAMMING
*Please review the Application Guide before completing this form. The Application Guide can be found here:
http://www2.gov.bc.ca/gov/content/safety/crime-prevention/community-crime-prevention/grants
SECTION 1. APPLICANT INFORMATION
Project Title:
Legal Name of Organization:
Business Name of Organization:
Location of Project (specify city/cities):
Organization’s GST/Business Number:
Applicant’s Mailing Address (Street and
Number):
Suite Number:
City/Town:
Province:
Postal Code:
Physical Location (if different from
mailing address):
Contact Person 1:
Telephone:
Email:
Contact Person 2:
Telephone:
Email:
Type of Organization (Please select one)
Indigenous Organization (E.g. First Nations Band, Tribal Council, Friendship Centre,
Incorporated Non-Profit, Indigenous Community-Based Non-Profit, or registered charitable
organization, Urban/off reserve First Nation organizations such as Friendship Centres, Métis
chartered communities and Métis service providers).
Non-Profit Organization
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Has the project previously received a Civil Forfeiture Grant? If yes, please list which years the project
was funded.
Yes Years?
No
What was the date of the last cycle of your domestic violence prevention/intervention program?
Stream Focus: Domestic Violence Prevention/Intervention Programming
This stream provides up to $30,000 in one-time funding to organizations for the direct delivery of
domestic violence prevention/intervention programming. Funding will support organizations (including
Indigenous organizations) that presently deliver (i.e., have delivered at least one program cycle in the
past 24-months) domestic violence prevention/intervention group programming in community to
individuals who commit violence in intimate partner relationships. Programming must be delivered prior
to the charge, conviction or sentencing stage of the criminal justice process and must meet the needs of
the community it is being delivered to including the unique needs of Indigenous communities and
families.
Programming will contribute to the safety and wellbeing of victims who have experienced, or are at-risk
of experiencing, domestic violence.
Eligible Recipients
Not-for-profit organizations based in British Columbia
Indigenous organizations based in British Columbia (First Nations Bands or Tribal Councils, First
Nations organizations incorporated as a not-for-profit society or registered charitable organization,
Urban/off reserve First Nation organizations such as Friendship Centres, Métis chartered
communities and Métis service providers).
PROJECT EXECUTIVE SUMMARY:
Provide an executive summary of the project which should include the project’s name, objective,
target group, whether the program is delivered prior to the charge, conviction or sentencing stage,
and types of activities to be implemented. Provide a maximum of 5 sentences.
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SECTION 2: CLIENT REACH & GEOGRAPHIC AREA
a. What is the anticipated number of participants and number of cycles for the duration of the grant?
b. What is the geographic area/community of program delivery?
c. Will this programming be delivered in Indigenous communities?
SECTION 3: LEVEL OF NEED
Why is there a need for this programming in the specific community of delivery? Highlight any
evidence (e.g., research, data, anecdotes) demonstrating this need in your community. How will/does
the program meet the needs of the community it is being delivered to, including the unique needs of
any Indigenous communities and families it serves?
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SECTION 4: PROJECT GOALS/OBJECTIVES
What are the objectives/goals of the project? What are you hoping to achieve? How will you
measure success/how will you know if you’ve met your objectives/goals?
SECTION 5. MANDATORY REQUIREMENTS
Please explain how the program meets the following four mandatory requirements:
a. Programming must be culturally relevant, culturally safe, and trauma informed.
b. The program must be delivered by one or more qualified practitioners (e.g. Elders,
counsellors, facilitators) who understand the potential challenges and successes in working
with those who have a history of domestic violence.
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c. Programs must include pre-planned curriculum, with different topics presented each session,
learning objectives, and program outcomes.
d. Programs must be delivered in a group setting.
In unique circumstances where an organization needs or wants to deliver their programming in a
non-group setting, an exception to this requirement may be made. Organizations wishing to be
considered for this exception should clearly articulate why the group format is inappropriate in
the context in which the program is delivered (e.g., community population is not large enough to
gather enough clients for a group).
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SECTION 6: PREFERRED CRITERIA
Please use this checklist to articulate if and how the program you offer meets the following preferred
criteria.
YES
NO
a. Prioritizes the values of anti-violence work
Prioritizes and emphasizes the values of anti-violence work and safety of victims and
children in all aspects of program delivery including assisting victims/survivors to
understand that the perpetrator's participation in a behaviour change program is not
guaranteed to result in the perpetrator stopping violence.
Does your program engage with local, relevant community members to support the
victim (e.g., Elders, nurses, police, other community members)?
Does your program use safety assessments?
Does your program have an established referral protocol to local community-based
victim services/violence against women services?
Does your program have processes to invite contact with victims, where appropriate,
during initial intake, throughout program delivery and/or afterwards?
Does your program provide information and resources on where to access support,
referrals to appropriate services, and general information about the program to
partners, family and in particular victims and children?
Use this space to provide any additional information or examples about the emphasis your program
places on the values of anti-violence work and safety of victims and children.
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YES
NO
b. Theoretical and Therapeutic Approach
Does your program take an eclectic approach in order to meet the unique needs of
participants from different communities and in recognition that there is no one
approach or theory that works for all programs? This may include drawing on a blend
of theoretical foundations that may include elements of social learning, feminist,
response-based, and/or systems theory, and incorporating a variety of therapeutic
techniques (e.g., psychoeducational, cognitive behavioural, trauma informed practice
etc.) as well as cultural practices.
Use this space to provide any additional information about your theoretical and therapeutic
approach.
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NO
c. Does your program include the following topics:
Culture and healing
Assertiveness and communication skills
Healthy relationships
Conflict resolution and management
Empathy and accountability
Self-Esteem
Impacts of substance use
Trauma (including the impacts of intergenerational trauma) and mental health
Impacts and types of abuse
Parenting and caregiver skills
Controlling behaviours
Thought patterns, attitudes, and beliefs
Use this space to provide any additional information about your program topics.
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NO
d. Screening and Intake Assessments
Does your program include careful screening and intake assessments that determine
suitability and/or readiness of applicants and provide some early insights into an
applicant’s behaviours, thinking, and attitudes?
Does your screening and intake designate as ineligible applicants who:
Have serious charges/highest risk individuals that may be better served by a different
form or level of intervention?
Are assessed as having a high-level of denial/unwillingness to change?
Are found to have serious mental health or substance use illness at levels
contradicting group therapy?
Are determined to be openly hostile and disruptive to the group/cohort process?
Use this space to provide any additional information about your screening and intake process.
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NO
e. Focus on Prevention and Relapse
Does your program recognize that the nature of domestic violence requires a focus on
prevention of relapse to sustain behaviour change and thus prioritize client retention
and continued supports for clients after a program cycle ends?
Does your program include strategies or incentives to improve client retention?
Does your program include resources and tools for clients upon completion?
Does your program involve after care groups for clients who have completed the
program and/or processes that allow clients to participate as mentors?
Does your program encourage participants to engage in community and cultural
events after the completion of the program?
Use this space to provide any additional information or examples about the focus your program has
on prevention of relapse.
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SECTION 7. PROJECT BUDGET
Proposals must contain a reasonable and detailed budget. Consideration will be given to the scope and reach of the project in comparison to the amount of the budget (i.e., value for money). Please round all amounts to the nearest dollar.
All budget items listed must correspond to your project activities as described above. For a list of eligible and ineligible expenses, please refer to the Program Guidelines.
Example: Staff: 1 Facilitator x $22.50 per hour x 3 hrs/week x 40 weeks = $2700
Budget Item
Description
Amount
Requested
Amount from
Other Sources
Total Project
Expenses
Staff
Program Facilitators
Director
Administrative Staff
Consultants/Professional
Fees/ honoraria
Other
Non-Staff
Administrative Fees (not
to exceed 15% of overall
budget)
Rent/Utilities
Equipment/Supplies
Recruitment/Outreach
Activities
Printing/Copying of
Client/Victim Materials
Travel
Other
TOTAL
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SECTION 8. DECLARATION
To be signed by an authorized signatory of the sponsoring organization, by signing you agree:
The information contained in this application is accurate and complete;
The application is made on behalf of the sponsoring organization named with its full knowledge
and consent;
The sponsoring organization is a registered legal entity in good standing;
The sponsoring organization has an appropriate accounting method to manage any potential
grant funds;
Should a project be approved, the sponsoring organization is required to submit a midterm and
final report. The reports should detail progress against the activities and outcomes described in
the application and how the grant funds are being/were spent. A link to both reporting
templates will be provided to you if your proposal is successful.
Name of Authorized Representative:
Title:
Signature:
Date:
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