MENTAL HEALTH RECOGNITION DINNER MINI-GRANT 2013 Due No Later than Friday, July 12, 2013 Applications must

be sent to: Minigrants2013@yahoo.com -------------------------------------------------------------The Mini-Grants are made available from the funds raised at the Annual Behavioral Health Recognition Dinner. The mini-grants are intended for groups and agencies working with consumer populations. All requests will be reviewed to ensure they are focused on client benefit and not specific to an individual or practice. Although the Mini-Grants are not large amounts of money, they do assist in providing supplies for client needs and events. To that end, the mini-grants are given in the form of gift cards. Three stores are made available in order to best provide options for how the grants will be used. Please select only one of the stores when making your decision. The form must be completed and submitted no later than Friday, July 12, 2013. E-mail applications to: Minigrants2013@yahoo.com. Please note that we will no longer be accepting applications via the US Postal service. The committee will review the requests upon their receipt and minigrants will be hand delivered to each recipient. We request that all receipts be kept on file with your organization for five years. Receipts may be subject to audits at any time. Please consider what would be most useful for your clients; something that your program can truly benefit from. We recommend that you send in your requests as soon as possible in order to take advantage of this great opportunity! If you have any questions, please call Bindu Khurana at (619)641-6235 or email at Bindu.Khurana@optum.com Sincerely,

Bindu Khurana Chair, Mini-Grant Committee

MENTAL HEALTH RECOGNITION DINNER MINI-GRANTS 2013

Program Name: _________________________________________________________________________ _____ Parent Organization: ________________________________________________________________________ Address: _________________________________________________________________________ _____________ Contact Person: _________________________________________________________________________ _____ Contact Person preferred contact information (phone or email) _________________________________________________________________________ ____________ Please circle one preferred store to use the funds: VONS TARGET WAL-MART

The funds will be used to purchase:

We need this item for the following reason:

The item(s) will be used for the direct benefit of consumers in the following way: