East Dayton AWARE Project
MENTAL HEALTH FIRST AID
INSTRUCTOR SCHOLARSHIP APPLICATION
Mental Health First Aid (MHFA) is an in-person training that teaches individuals how to help
people who are developing a mental illness or who are in a mental health crisis. For more
information about MHFA, please go to www.mentalhealthfirstaid.org. The ADAMHS Board for
Montgomery County wishes to support MHFA trainings in Montgomery County. As such, we
are looking for qualified individuals to become certified MHFA Instructors.
This training scholarship process has been implemented to identify appropriate candidates who
are committed to providing MHFA trainings in conjunction with the East Dayton AWARE
Project (EDAP), an initiative that will conduct MHFA trainings on the east-side of Dayton to
individuals who live, work, worship, or serve in zip code areas 45403 and 45410. The
scholarship will pay for all registration fees and travel costs related to the Adult MHFA
Instructor training.
To apply for a scholarship, please complete the following application. All applications are due
no later than November 20, 2015 by 5:00 PM and should be sent to ahoff@mcadamhs.org. Late
applications will not be accepted.
Name
Organization (if applicable)
Title (if applicable)
Street Address
City, State, Zip Code
Phone Number
E-Mail Address
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Respond to the following questions as fully and succinctly as possible.
Why do you want to become a Mental Health First Aid Instructor?
What are your experiences and qualifications related to mental health?
What are your experiences and qualifications related to giving oral presentations?
Stipends
After becoming a certified MHFA Instructor, scholarship recipients will receive $150 per
completed MHFA training conducted on behalf of EDAP during the first year of the program.
This stipend amount may increase in subsequent years. Stipends will be waived for individuals
who are being paid by an employer during the time they spend conducting MHFA trainings on
behalf of EDAP.
Expectations
Scholarship recipients will be required to attend a five-day MHFA Instructor Training which will
be held December 7-11, 2015 in the Dayton, Ohio, area. Additional meetings will be held on an
as needed basis with attendance being required. Scholarship recipients will also be required to
provide a minimum of four complete MHFA trainings per calendar year for three years under the
supervision of the EDAP Project Coordinator and will not provide this training for charge until
the three-year grant is completed.
Equal Opportunity Policy
It is the policy of the ADAMHS Board for Montgomery County to provide equal opportunities
without regard to race, color, religion, national origin, gender, sexual preference, age, or
disability.
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Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I
understand that if I am selected to receive a scholarship, any false statements, omissions, or other
misrepresentations made by me on this application may result in my immediate dismissal from
receipt of future training scholarships. If I receive a scholarship, I agree to attend the entirety of
the training. I agree to provide a minimum of four complete MHFA trainings per calendar year
for three years under the supervision of the EDAP Project Coordinator. I also agree that I will
not provide this training for charge until after the three-year grant is completed.
Applicant Name
(printed)
Applicant Signature
Date
Supervisor Commitment
If the applicant will be receiving payment by an employer during their participation in EDAP,
the applicant’s employer must support the applicant’s application and full participation. If this is
not the case, please write “N/A” on the lines below.
My signature verifies that I am the direct supervisor of the applicant listed on this application and
that I fully support the applicant’s attendance at the December 7-11, 2015 MHFA Instructor
training and all future MHFA meetings and trainings the applicant attends on behalf of EDAP.
Supervisor Name (printed)
Supervisor Signature
Date
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EDAP Travel Policy
This policy is intended to serve as a guide for the proper processing of various travel activities.
Scholarship Recipients are expected to exercise good judgment and make expenditures in a
prudent manner, consistent with the highest ethical standards and the need to expend public
funds in a frugal and economic manner.
A.
Registration fees, airfare, and lodging will be paid for in advance by the ADAMHS
Board for Montgomery County. These items will require authorization by the Board
prior to obligating the Board to any related expenses and will follow all policy guidelines
established in this document.
B.
Scholarship Recipients will receive reimbursement for authorized expenses incurred
while traveling, provided the policy has been followed as specified in this document.
Expenses shall be reimbursed following submission of true and actual receipts which
document the prior authorized training. Scholarship Recipients must submit to
ADAMHS an invoice and all original receipts verifying expense amounts and purpose.
Receipts must be itemized. Non-training related items are not subject to reimbursement.
Expenses, which are approved, shall be reimbursed in the following manner.
 Mileage: Scholarship Recipients shall be reimbursed for actual miles traveled, at the
mileage rate approved by the Montgomery County Commissioners at the time of travel,
when using their personal vehicle. Such payment is considered to be total reimbursement
for all vehicle-related expenses (e.g., fuel, oil, insurance, depreciation, etc.). A detailed
account of actual miles traveled showing the starting point, destination, and total miles
traveled, must be provided. A template for invoicing for mileage expenses will be
provided.
 Parking and Tolls: Charges incurred for parking at the destination, and any highway
tolls are reimbursable at the actual amount.
 Meals: Expenses incurred for meals when overnight travel is required are reimbursed
consistent with Montgomery County policy. The maximum meal reimbursement for
authorized County travel is $50 per day. All requests for meal reimbursement must be
accompanied by properly executed receipts. There is no reimbursement for any meals
which are included as part of the program/event package, even if the attendee chooses to
forego the provided meal.
 Meals for Partial Day Travel: If the travel occurs over a partial day, only the portion of
the day in which travel actually occurs will be considered for the per diem rate. For
example, if travel concludes by 6:00 PM, dinner is not reimbursable.
 Motel and Hotel Expenses: Expenses covering the actual cost of a motel or hotel room
(single room rate) will be paid for, in advance, when the Scholarship Recipient travels out
of Montgomery County, and such travel requires an overnight stay. Original receipts
must be submitted upon completion of the training.
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C.
D.
Conference Sponsored Motel and Hotel Expenses: The Board will pay for the lowest
available single occupancy conference rate for on-site lodging at the MHFA Instructor
training program.
Alternative to Motel or Hotel Lodging: Should the Scholarship Recipient stay with a
friend or family member in lieu of a motel or hotel room, the Board will reimburse the
Scholarship Recipient $15.00 per day as an incentive to reduce lodging costs.
Air and Other Common Carrier Travel: Travel by air, bus, train or other common
carriers shall be undertaken at the lowest rate reasonably available. ADAMHS will
coordinate airfare and other common carrier travel details in conjunction with the
Scholarship Recipient and will pay for these expenses in advance. ADAMHS WILL
NOT REIMBURSE FOR FIRST CLASS TRAVEL. If a Scholarship Recipient chooses
to travel at any rate higher than the lowest (coach/economy rate) s/he must personally pay
the difference in costs.
Alternatives to Common Carriers: As an alternative to common carrier, the
Scholarship Recipient may choose to use his or her privately owned automobile for travel
and be reimbursed in accordance with current Montgomery County reimbursement
policies. The Board reserves the right to prescribe the most appropriate and economical
method of travel based upon the circumstances of each individual case.
Registration Fees: Registration fees for MHFA Instructor training will be paid for by
ADAMHS in advance. Recipients must submit verification of their attendance at the full
MHFA Instructor training to the EDAP Project Coordinator at the completion of the
training.
Non-Reimbursable Expenses: Expenses which will not be reimbursed include the
following.
1. Dry cleaning
2. Cosmetics/personal needs
3. Parking tickets, traffic fines, and related costs
4. Privately owned vehicle repairs
5. Alcoholic beverages
6. Gratuities which exceed standard practice
7. Entertainment
8. Personal telephone calls
9. Snacks
Receipts are required for the following:
1. Air, bus, and train travel
2. Taxi, limousine and airport shuttle fares
3. Pre-authorized automobile rentals
4. Hotel and motel rooms, including taxes
5. Parking fees greater than $1.00
6. Training registration fee
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E.
F.
G.
H.
Receipts are not required for the following:
1. Toll road charges
2. Parking fees equal to or less than $1.00
3. Mileage on privately owned vehicle [however, the Board may verify mileage
claims by any reasonable means, including requiring statements of actual
odometer readings and inspection of vehicle odometers].
Requests for reimbursement must be submitted no later than 60 calendar days after
incurring the expense, or no later than 30 calendar days after the end of the fiscal year,
whichever occurs first, or the receipt of an invoice for such expense, whichever is later.
Any request submitted after such period is not eligible for reimbursement.
Scholarship Recipients who falsify any claimed expense may be subject to appropriate
legal action up to and including prosecution for theft.
Notwithstanding the above, the Board retains the authority to disapprove any expense,
including [but not limited to] mileage, motel rooms, and meals which the Board
determines is inappropriate, insufficiently documented, excessive, or not in accordance
with this policy.
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