PLAY PROGRAM
PARTNER REAPPLICATION FORM 2017/18
The Promoting Life-skills in Aboriginal Youth (PLAY) program supports its partners to deliver fun, safe and
dynamic extracurricular programs for children and youth. Right To Play staff provide training and coaching
for a local youth worker and collaborate with them to design, launch, lead and measure the success of
these youth programs.
This application is for First Nations, Métis and Inuit communities and urban Indigenous organizations
situated in British Columbia, Alberta, Manitoba and Ontario who are currently partnered with Right To Play.
This application must be completed by the Community Mentor, Community Supervisor, and/or someone
who is familiar with the program.
Note:


Before completing this application, please ensure that you have read the revised PLAY Application Guide.
Should you need technical assistance in completing this application please contact your Program Officer for
further support.
APPLICANT INFORMATION
Name of Community or Urban Indigenous Organization:
Primary Contact:
Unit No./PO Box
Title:
Street No.
Telephone No.
Street Name
Fax No.
Province
Postal Code
E-mail Address
*Primary contact will be contacted if more information is required, and will be the main contact throughout the
application process. This should be someone who can be reached easily by phone and email from May 30th to July
18th, 2017 while the review process/interview and subsequent agreement period is underway.
COMMUNITY, URBAN INDIGENOUS ORGANIZATION SUPPORT DETAILS
By signing below you are confirming that:
 All of the information in this application is true to the best of your knowledge
 Each signatory is in full support of and accountable to implementing a core PLAY program in the community
and will promote its development.
(MANDATORY FOR ALL APPLICANTS)
Chief or Councilor (Community)/Executive
Signature:
Contact Number:
Director (Urban Organization)
Printed Name:
Current Community Supervisor
Printed Name:
Signature:
Contact Number:
Finance Administrator or Signing Authority
Printed Name:
Signature:
Contact Number:
Current Community Mentor
Printed Name:
Signature:
Contact Number:
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FOR FIRST NATIONS COMMUNITIES ONLY:
Will the community pass a Band Council Resolution (BCR) in support of this initiative (If applicable)?
☐ YES
☐ NO
APPLICANT SELF-ASSESSMENT
Please use the following checklist to assess the impact that another year of the PLAY program would have on your
community or urban organization, as well as to assess your community or urban organization’s eligibility for the PLAY
program.
Please note that if this portion of the application is left blank you application will not be considered.
Please check all options that apply:
Are you applying on behalf of a First Nations, Métis or Inuit community or an urban Indigenous organization?
☐ First Nations, Métis or Inuit Community
☐ Urban Indigenous Organization
How long have you been a partner with Right To Play?
☐ As a part of our commitment to our partners, Right To Play is able to fund 50% (up to $20,000) of a youth
worker’s salary. Would your community and/or urban organization be able to support half of a youth worker’s
salary?
☐ My community and/or urban organization still shows much support for the program.
Through another year-long partnership with Right To Play, which resources are you keen in accessing?
☐ Program funding
☐ Coaching and training for a youth worker
☐ Resource and program development materials
☐ Event participation (Youth Worker Trainings, Sport Clinics)
In the event that none of the above options apply to your community and/or urban organization, please contact
Jasmin Glaw by phone (416) 203-0190 ext. 355 or by email [email protected] for further information on the
PLAY program or for recommendations on how to proceed with this application.
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REFLECTIONS/LOOKING BACK:
To be completed by Community Mentor and Community Supervisor
The following questions are designed to capture an overview of PLAY programming over the last year.
1. Check any examples of results the PLAY has had on the youth in the program and/or community members
(check all that apply)
☐ Increased self-esteem
☐ Decrease in bullying
☐ Decrease in vandalism, substance use and/or delinquency
☐ Increase in understanding of/engagement with local culture and history
☐ Increase in connections between children/youth and Elders
☐ Enhanced relationships between youth in the community
☐ Enhanced relationships between neighbouring communities
☐ Enhanced positive coping skills
☐ Increased hope for a positive future
☐ Increase in youth taking on leadership roles within the program
☐ Increase in youth taking on leadership roles within the community
☐ Increased physical activity
☐ Increased healthy eating
☐ Enhanced pride in community
☐ Increased motivation among youth to pursue further education
☐ Increased youth interest/motivation to find employment
☐ Increase in youth advocacy around community change
2. Use the space below to describe specific examples of the results you’ve indicated above that the PLAY
program has had in your community that you identified in the previous question. These examples can be
based off of testimonials, feedback received and/or firsthand experience (maximum 500 words):
3.
i.
Which program pillar(s) did your program focus on last year?
☐ Improved Education
☐ Improved Health
☐ Healthy Relationships
☐ Youth Employability
ii.
How do you feel your program created positive change in youth participants in relation to this area of
focus/pillar? Please provide examples. (maximum 500 words)
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4. Please attach 3 letters of support from community members (children and youth participants, parents,
teachers, etc.) who have been a part of the program. These letters should tell us about their experience in or
with the program and how it has impacted the community and/or urban organization. Applicants are highly
encouraged to include a minimum of one youth-written letter.
NOTE: These letters will strengthen your application
Complete the guide below for the attached letters of support:
Name
How is this person connected to the PLAY program?
Is this person
a youth?
(Y/N)
5. Describe the structure of the PLAY program in your community and/or urban organization by filling out the
chart below:
Program Type
Frequency of
Approximate Number Ages of Participants
Program Supports
(Youth Leadership
Programs
of Participants
(ex. 12-15 years)
(volunteers, elders,
Program, Play for
(ex. Every Tues
etc.)
Prevention, etc.)
and Thurs 58pm)
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6. List the partnerships (implementing, funding, and/or in-kind) who have helped to support the PLAY program
in your community and/or urban organization. Where applicable, please provide 1-2 sentences per
partnership that explain how the partnership has supported/benefited the PLAY program.
Name of Partner
Type of Support and Benefits of Partnership
Number of Years
(1-2 sentences)
Partnered (if applicable)
7. Describe at least two different challenges that the program has encountered this past year and propose
detailed strategies and action steps to overcome these challenges in the next program year. (i.e., insufficient
program space, insufficient office space and/or equipment, low attendance, lack of support etc.)
NOTE: the challenges DO NOT negatively impact your submission. Applicants are encouraged to share challenges to
demonstrate growth and continual improvement.
Challenge
Strategies or Action Steps to Overcome Challenge
1.
2.
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VISIONING/LOOKING FORWARD:
To be completed by Community Mentor and Community Supervisor
The following questions are designed to provide an overview of what your goals and overall vision are for the PLAY
program in your community and/or urban organization for 2017/18.
8. Why does your community and/or urban organization want to see the PLAY program extended for another
year? What could be the impact?
a) What are the strengths of and challenges for children and youth in your community and/or urban
organization?
b) Where do you want the children and youth in your community and/or urban organization to be in
5 years?
c) How would the PLAY program help you achieve your vision for the children and youth in your
community and/or urban organization? What would another year of the PLAY program look like?
d) What is the specific need(s) you are hoping to address through the PLAY program if you are
accepted into the 2017/18 year?
9. Each PLAY program focuses on achieving specific outcomes for children and youth, these program pillars
include:
 Improved Health: Many of our partners struggle with issues such as childhood diabetes and
obesity often resulting from a lack of physical activity, knowledge of healthy eating and lack of
access to healthy foods. Programs focusing on this outcome area work against this by focusing
their program on preventing these areas and building healthier, more active communities.
NOTE: All urban organizations will be working toward this pillar.
 Improved Education: In communities experiencing low educational attainments, poor
educational outcomes and/or high dropout rates they may choose to focus on Education as
their major outcome area. Programs that choose this focus may work closely with teachers and
schools, integrate homework into their program or build educational (literacy and numeracy)
games into the fabric of what they do.
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

Healthy Relationships: Within the context of the PLAY program building healthy relationships
means building self-confidence in youth, increasing positive peer relationships between youth
and ensuring youth have a strong network of support. Each of these pieces are essential to
promoting overall well-being and supporting the development of coping skills and mental health
amongst children and youth.
Youth Employability: For communities seeking to build positive futures for children and youth
they may choose to support youth in building the skills they need to succeed in the workplace as
well as to seek meaningful employment and training opportunities.
Please fill in the following chart:
Select 1-2 Program Pillars
Why did you select this pillar?
How could its teachings be
beneficial to the children and youth
in your community and/or urban
organization?
1.
2.
10. What types of activities would you like to incorporate in your PLAY program?
☐ Team building games
☐ Sports
☐ Arts and Crafts
☐ Educational Games (Literacy, Numeracy)
☐ Cultural Programming
☐ Food and Nutrition
☐ Leadership Activities
☐ Planning Opportunities
Other:
NOTE: All partners will lead the design of their PLAY program with support from Right To Play staff upon successful
completion of the PLAY program application process.
11.
i.
Which age group are you hoping that the PLAY program would reach?
☐ 6-12
☐ 13-18
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ii. Please explain why you are targeting this age group and how you think this program will be of benefit.
12. Do you plan to continue using the same program structure as last year in the coming year? Please explain.
(500 words maximum)
In your answer, you must tell us about:
For Community Partners:
a) Strengths and/or challenges of your current program structure.
b) Elaborate on your vision of the program structure for the coming year and how this structure will
contribute to further achieving your program goals.
c) How you would like to enhance/grow your program reach.
For Urban Organizations:
a) What have been some of the biggest strengths of your Play For Prevention program this past year?
b) What have been some of the challenges?
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c) What changes do you plan to make to you program to address/overcome them?
13. List any new internal or external partners you would like to approach in order to enhance the program
(implementing, funding and/or in-kind). Provide 1-2 sentences for each, explaining what you would aim to
achieve through the partnership.
Name of Partner
Role of Partner
Reason(s) for Creating
this Partnership (1-2
sentences)
Benefit(s) of Creating this
Partnership (1-2
sentences)
14. All Right To Play programs aim to build on the existing strengths of individuals, communities/organizations
and partners, in the hope that one day Right To Play will no longer be needed. Does your program have a
clear phase out and/or sustainability strategy?
Note: Not having a phase out and/or sustainability strategy will not affect your application.
☐ YES
☐ NO
If you selected Yes, please answer the following set of questions, (maximum 500 words)
a) What outcomes you hope to maintain/improve upon after the completion of the partnership with
Right To Play?
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b) How will Right To Play activities be phased out or handed off to local players?
c) How will the community and/or urban organization prepare for the close of the partnership?
d) What is your expected sustainability timeline?
STAFFING AND REPORTING:
To be completed by the Community Supervisor or Primary Application Contact
The success of the PLAY program is very dependent on the people who are selected or assigned to lead the
program locally. The following questions will help us understand what kind of support your community could
realistically provide.
15. In order to facilitate the program locally, Right To Play requires the community or urban organization to hire a
Community Mentor.
Community Mentor – The role of the Community Mentor, typically a full-time position, is to
implement the PLAY program on a regular, weekly basis. Community Mentors are required to deliver
a minimum of 8 hours of programming each week, in addition to time spent planning
sessions/events and preparing monthly Monitoring & Evaluation and Financial Reports. Community
Mentors will also attend two mandatory week-long trainings and one Youth Leadership Symposium
each program year that take them outside of their community; with all expenses paid for by Right To
Play.
i.
Is there someone who has already been identified to take on the role of Community Mentor for the PLAY
program for 2017/18?
☐ YES
☐ NO
ii.
If yes, please explain what makes this person a strong candidate (describe their work ethic, past
experience, attitude, etc.). (250 words maximum)
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iii.
Is the identified candidate able and committed to leading a minimum of 8 hours of direct programming
per week with children and youth?
☐ YES
☐ NO
If no, please explain:
16. Please describe the current policy for CPIC and Criminal Reference checks for youth workers that is specific
to your community and/or urban organization.
17. Each applicant who is selected to partner with Right To Play is required to submit the following monthly
reports to a strict deadline:
 Detailed Monthly Financial Reporting
 Monthly Program Report
 4 sets of Program Evaluations
(Please see the PLAY Application Guide for further details)
i.
In the past year did the Community Mentor complete these reports effective and in a timely manner?
☐ YES
☐ NO
If no, please explain why and how you, the Community Supervisor, will help to ensure that the Community
Mentor meets his/her deadlines next year.
ii.
Has your community and/or urban organization been designated a Program In Difficulty (PID) within the
last program year?
☐ YES
☐ NO
If yes, why and what was the action plan that resolved those issues? How do you plan on avoiding
Program in Difficulty (PID) in future?
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18. In order to provide local support and guidance to the Community Mentor, each community must assign a
Community Supervisor.
Community Supervisor – The role of the Community Supervisor is to offer support and supervision to
Community Mentors on a day-to-day basis. The Community Supervisor should be someone who
already has a salary within the community and/or urban organization and who will be available to
support and supervise the Community Mentor as part of their existing role.
If the partnership continued for an additional year, is there someone in the community and/or urban
organization who has already been identified to take on the role of the Community Supervisor if your
community is selected for the PLAY program in 2017/18?
☐ YES
☐ NO
If yes, please explain what makes this person a strong candidate (describe their work ethic, past experience,
attitude, etc.). (250 words maximum)
19. As the Community Supervisor, would you be available to participate in phone calls with Right To Play on a
regular basis to discuss the progress of the program or to communicate with Right To Play staff when
necessary?
☐ YES
☐ NO
If no, please explain.
20. As the Community Supervisor, how would you respond if the Community Mentor was not meeting their
responsibilities or running a consistent program? (i.e. Not meeting financial, programming and/or monthly
reporting requirements) (maximum 250 words)
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FUNDING AND IN-KIND SUPPORT
The Promoting Life-skills in Aboriginal Youth (PLAY) program would not be possible without the important
partnerships that have been formed with many visionary organizations. We are grateful to the following
organizations that fund the program.
Adam van Koeverden
Jays Care Foundation
Bruce Power
The Calgary Foundation
KPMG Foundation
The Lawrence and Judith
Tanenbaum Foundation
The London Community
Foundation
Microsoft
Miziwe Biik
Carillion Canada
Cenovus
The Catherine and Maxwell
Meighen Foundation
Goldcorp
Hydro One
Indigenous and Northern Affairs
Canada
MLSE Foundation
Ontario Ministry of Indigenous
Relations and Reconciliation
Ontario Ministry of Child and Youth
Service
Ontario Ministry of Economic
Development, Employment and
Infrastructure
Public Health Agency of Canada
RBC Foundation
The Slaight Family Foundation
Suncor Energy Foundation
Sun Life Financial
TransCanada
True Sport Foundation
The Winnipeg Foundation
21. Are there any donors listed above that your community and/or urban organization would not accept funding
from?
☐ YES
☐ NO
If yes, please explain.
NOTE: Not accepting funds from a particular donor will not impact the chance of receiving the program. Rather, this
information will help Right To Play determine how best to fund the program in your community and/or urban
organization.
22. What is the expected annual salary for someone in the position of local youth worker in your community?
23. Right To Play expects the community and/or urban organization to finance at least 50% of the Community
Mentor’s salary. As such, Right To Play will provide the other 50% (up to $20,000) of the salary costs for the
first 6 months of the program year, and the partner community will cover salary costs for the latter part of
the program year (beginning approximately March 1st, 2018).
How much can your community or urban organization contribute to the salary? Please list a dollar or
percentage amount.
NOTE: Communities that can fund 80-100% of the Community Mentor’s salary strengthen their chances of receiving
the program
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24.
i.
In order for the Community Mentor to do their job effectively, they will need an office and
supply storage space as well as equipment (i.e. phone, computer, printer, fax etc.). Will
you able to provide these for the Community Mentor free of charge?
☐ YES
ii.
☐ NO
Where do you anticipate the Community Mentor’s office will be located?
25. In order to provide regular and consistent programming for children and youth, there needs to be a free,
permanent venue available for the program 3 to 5 times each week. An ideal venue should be large enough
to safely accommodate 20+ children and include access to an indoor play space for sports and games.)
Will your community and/or urban organization be able to provide this free of charge?
☐ YES
☐ NO
Please describe the anticipated venue:
26. As a part of our partner agreement, the PLAY program provides in-community support visits from Right To
Play staff for 2-3 visits per year (approximately one week in length per visit). The partner agrees to provide an
in-kind contribution of a safe, private space for Right To Play staff to stay during those visits.
Will your community and/or urban organization be able to adhere to this in-kind contribution? (i.e. hotel
room, motel room, teacher’s accommodations, house, etc.)
☐ YES
☐ NO
If yes, please describe (e.g. hotel room, motel room, teacher’s accommodations, house, etc.):
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ADDITIONAL QUESTIONS AND COMMENTS:
To be completed by the Community Mentor and Community Supervisor
The Sustainable Development Stream is a new and exciting opportunity for community and urban partners that
want to develop, design, and lead sustainable youth programs that are able to thrive beyond the standard
partnership with Right To Play. The stream will allow you to opt out of certain aspects of the regular partnership
and opt into monthly capacity building opportunities to support you in the development and delivery of a fully
community-owned youth program!
Your community and/or urban organization is eligible for the program stream if you meet all the criteria below:
Your Community or Urban Organization:




Has partnered with Right To Play for 2+
program years
Is content with the quality of your youth
program
Is ready and able to seek out alternative
funding and training models to support the
continual development of the program
Has a group of community stakeholders
who are willing to take on increased
responsibilities for program management
and receive monthly remote trainings from
Right to Play.
Your Community Mentor:



Consistently meets or
exceeds their job
responsibilities
Has the desire to train
other youth workers
Is committed to
participating in monthly
remote trainings from Right
To Play
Leadership in Your Community
or Urban Organization:



Possess a strong vision for the
future of youth programs
No longer require program
management support from
Right To Play
Are committed to increasing
the community ownership of
the PLAY program
27. Is your community or urban organization interested in enrolling in the Sustainable Development Stream with
the PLAY program this year?
Please note that only communities and urban organizations that fit all criteria will be considered.
☐ YES
☐ NO
If you check ‘yes’ a Right To Play team member will follow up with further information and next steps.
The goal of the Sport For Development (S4D) program is to provide children and youth with the opportunity to
participate in a variety of sports that go beyond the traditional skill development and instead focus on the
development of the whole child or youth. Through this program stream children and youth participate in safe and
inclusive sport-based activities that are designed to build a sense of confidence, leadership and teamwork as
opposed to emphasizing skill-development or competition. Activities may include sport-specific clinics; community
based sport events; coach training; inclusive sport within regular weekly programming.
28. Which sports and/or recreation activities would the youth in your community and/or urban organization be
most interested in?
☐ Lacrosse
☐ Hockey
☐ Basketball
☐ Soccer
☐ Baseball
☐ Volleyball
☐ Land-Based/Outdoor Recreation
Other Sports:
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Other Recreation Activities:
29. With regards to sport programming, what areas of support are you interested in?
☐ Right To Play lead trainings
☐ Sport & Recreation Clinics
☐ Coach Training (NCCP)
☐ Equipment
☐ Support Visits
☐ Inter-Community Event Support
☐ League Development
Other:
Invitation to participate the Aboriginal Children’s Health and Well-Being Measure (ACHWM)
About the Aboriginal Children’s Health and Well-Being Measure (ACHWM):
The ACHWM initiative was conceived by Mary Jo Wabano, Health Services Director for Wiikwemkoong First
Nation, and Dr. Nancy Young, Laurentian’s Research Chair in Rural and Northern Children's Health. The
project actively engaged Aboriginal children and youth to design a culturally-appropriate survey that
captures the spectrum of illness to wellness. The ACHWM is a comprehensive health and well-being
survey (62 questions) that is culturally appropriate in its design and reflective of the unique voices of
children and youth.
Collaboration with Right To Play
 Right To Play’s goal in sharing this opportunity is to provide community partners with a chance to
assess the overall health and well being of children and youth to help inform what types of
programming and resources would be most useful and relevant for youth in the community
 Communities can determine whether data from the survey is shared with Right To Play. Any data
shared with Right To Play will be kept confidential with no identifying information.
Key benefits of the ACHWM for Communities
 Cost-sharing model will enable communities to use the ACHWM tool at little to no cost
 The ACHWM can help communities to assess of the impacts of all youth programs at a local level.
 Offers children an opportunity to have their voices heard through self-report.
 Generates quantifiable data that is relevant to First Nations as a base for funding applications
and long term sustainability of the program
 The survey process includes a screening mechanism, which alerts local health teams to
respondents experiencing health challenges and provides opportunities to connect with supports
(e.g. mental health).
 The ACHWM is culturally-relevant, scientifically sound (valid, reliable, and sensitive), and feasible
to implement in contexts where resources might be limited
Key Considerations for Communities:

Participation is completely voluntary

Capacity must exist in the community to follow-up and support children and youth who have been
identified through the screening mechanism as requiring additional health support. This would
require a commitment from mental health workers and Chief and Council to support the use of
this tool.

The tool is grounded in the medicine wheel and may require adaptation for specific community
cultural context
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30. Would your community be interested in using the ACHWM in your community?
☐ YES
☐ NO
31. Does the community have the capacity to follow up with and support youth who have been identified through
the screening process as requiring additional health support (e.g. mental health worker)?
☐ YES
☐ NO
32. Use the space below to explain anything else the selection committee should consider when reviewing your
application
Thank you for your application and interest in the Promoting Life-skills in Aboriginal Youth
(PLAY) program!
All applications must be received by
Friday May 26th, 2017 by 5:00pm (local time)
APPLICATION SUBMISSION
You can submit your application in the following ways:
1. Electronically:
Fax: 1 (519) 250-1088
Email: [email protected]
2. Mail
Attn: Jasmin Glaw
Promoting Life-skills in Aboriginal Youth (PLAY) Program Coordinator
Right To Play Canada
18 King St E, 14th Floor
Toronto, ON Canada
M5C 1C4
If you have any questions or comments about the application process, please contact:
Jasmin Glaw, PLAY Program Coordinator
Phone: (416) 203-0190 ext. 355
Email: [email protected]
NEXT STEPS:
All applicants will be contacted regarding their submission starting Tuesday July 11th to Tuesday July 18th, 2017.
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