TACKLING TOBACCO
Regional Grants Application Form
2012-13
Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
Overview
There are three sections in your grant application:
Section 1: Application Guide
This section provides background information to help you complete your grant application.
Section 2: Project Outline
This section outlines how your organisation intends to use the grant.
Section 3: Regional Grant Administration
This section is required to access the funds and includes account details for payment of the grant.
Application Checklist

Please read Section 1.

Complete both Section 2 and 3 of the application for submission.

Make a photocopy of the application for your records.
Send your completed application to:
Kath Duggan
Mail: P.O. Box 570 Singleton, NSW 2330
Phone: 0467 749 748
Email: kathrynd@nswcc.org.au
Enquiries to:
Regional Program Coordinator,
Email: kathrynd@nswcc.org.au
Phone: 0467 749 748
Philip Hull, Tackling Tobacco Program Officer, Cancer Council NSW,
Email: philh@nswcc.org.au
Phone: 02 9334 1478
Cancer Council NSW Tackling Tobacco Regional Grant Application Form 2012-13
Section 1: Application Guide
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Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
Section 1: Application Guide
Summary
What are the aims of the grants?
The grants aim to help social and community service organisations to:

Develop environments that protect staff and service users from second-hand smoke.

Develop service environments that support service users to quit smoking.

Improve staff skills to support clients who are interested in quitting smoking
What specific activities can the funds be used for?
The regional grants are to help social and community services:

Buy nicotine replacement therapy (NRT) products, such as nicotine patches and gum,
that can be provided free to clients to help them quit; and/or

Pay for staff time to help introduce or improve smoking-related policy.
Examples of policy changes include:

Introduction of a smoke-free site;

Introduction of designated smoking areas;

Restrictions on staff smoking, and commitment to help staff quit;

Development of an organisational statement on the importance of addressing tobacco;

Development of orientation materials that outline smoking policies / protocols

Amendment of case management tools to include action on smoking in the case plan
More information about developing smoking related policies is given below, but our policy toolkit
also provides an excellent guide. More information about supporting disadvantaged smokers to
quit is available in our cessation guide.
How much money is available per grant?
$ 3,300.00
Please note that Cancer Council NSW will pay the additional GST.
The grant will also provide access to free one-day training to equip workers to provide improved
quality support for clients to quit smoking.
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Section 1: Application Guide
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Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
What is the deadline for applications?
Monday, 26 November, 2012
Who are the grants open to?
Non-government social and community service organisations in Cancer Council NSW Hunter
Region.
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Section 1: Application Guide
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Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
Background Information
The Tackling Tobacco Program
The grants are being offered as part of Cancer Council NSW’s Tackling Tobacco Program. The
Tackling Tobacco program encourages social and community service organisations to develop
policies and practices that support service users to quit smoking.
Whilst the smoking rate is now in Australia is now 18%, research consistently reports much higher
rates amongst disadvantaged groups, such as:

People living with psychosis – 66%

Homeless people – 77%

People with drug use disorders – 73%

People with alcohol dependence – 61%

Aboriginal pregnant women – 50%

Pregnant women with a drug use disorder – 82%

Lone mothers 18-29 years – 59%.
The health impacts of tobacco addiction are well known but the financial impacts have received
less attention. The most disadvantaged 20% of people in Australia have been calculated to spend
around 19% of their income on smoking, and smokers with more severe types of mental illness
have been estimated to spend one-third of available money on cigarettes.
Smokers are more likely to suffer from financial stress, for example, not being able to afford
household essentials. The early death of a family breadwinner through smoking-related illness can
plunge a family in poverty. Disadvantaged smokers are therefore not only the worse affected by
the health effects of smoking, but also by the financial and emotional impacts.
There is a need for targeted support to help disadvantaged smokers. Social and community
service staff are well placed to undertake activities to support disadvantaged smokers to quit
because they have the skills and expertise to encourage positive change in peoples’ lives, and
positive, established relationships with clients.
Tackling Tobacco Grants Project description
The project is offering three grants of $ 3,300.00 to services in the Hunter for smoking-related
projects.
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Section 1: Application Guide
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Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
Funds will be provided as a one-off payment. The grants can be used for two options:
Option 1:
To buy Nicotine Replacement Therapy (NRT) products such as patches, gum, lozenges, minilozenges, inhalers, and sub-lingual tablets (not including e-cigarettes, or electronic cigarettes).
The nicotine replacement is mainly provided to help clients quit, but some may also be provided to
staff.
Option 2:
To allocate funds to support staff time to develop non-smoking policies or purchase resources
(e.g., no smoking signs). Policy changes could include:

Progression to smoke free grounds

Implementation of designated smoking areas

Policies on staff smoking - for example restricting staff smoking with clients

Restrictions on smoking in service vehicles or rules protecting staff from second-hand
smoke on home visits.
More Information on Option 1 – nicotine replacement therapy:
Offers of free nicotine products have been shown prompt attempts to stop smoking and can attract
people to support programs. People on low incomes often say that the cost of nicotine products
puts them off quitting smoking.
Although nicotine patches are now subsidised via a doctor’s prescription in Australia, there are still
reasons to offer additional free nicotine replacement.
1. Disadvantaged smokers may experience barriers to accessing a doctor’s prescription,
particularly in regional areas.
2. There is no subsidy for nicotine products apart from the patch (such as gum).
3. Some people need additional nicotine to top up the patch in order to quit smoking.
Nicotine replacement can be provided directly to clients by your service or it can be provided in
collaboration with a local pharmacy. Previous grant recipients have often opened an account with
the pharmacy so clients can access the NRT with relevant advice. A doctor’s prescription is only
needed to access the Pharmaceutical Benefits Scheme subsidy for patches, not because nicotine
replacement is a prescription medication per se.
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Section 1: Application Guide
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Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
It should be noted that electronic cigarettes, also known as e-cigarettes, are not viewed as nicotine
replacement products for the purposes of the grant. Electronic cigarettes also cannot be legally
supplied in Australia. It is currently unproven that e-cigarettes are safe or help people quit smoking.
More information on option 2 - policy development:
Policy development provides a sustainable way to protect the health of service users and staff.
Smoke-free sites promote attempts to quit smoking. Smoke-free sites and designated smoking
areas also protect clients, staff, and visitors from second-hand smoke.
More details on policy options and helpful suggestions for implementation can be found in the
Tackling Tobacco project policy toolkit
Additional support for projects
To support grant sites, Cancer Council NSW will also provide:

Free training to help staff to develop skills to support people to quit smoking

Advice and assistance from Cancer Council NSW staff on how to integrate addressing
smoking with standard care without being too time consuming

Free policy and quit smoking resources (see support and resources on page 6).
How to Apply
Simply fill out the sections 2 and 3 of the form.
Applications will be assessed by the following criteria:

Sustainability – will a high proportion of staff members attend training, will there be
changes to policies, protocols or procedures

Achievability – are there clear and realistic objectives and a plan for achieving them,
capacity to achieve outcomes, and track record of running projects

Commitment – is there support from service management for the project, and plans to
promote the project, for example to local inter-agencies or local media

Collaboration – will there be with Cancer Council Regional Program Coordinators, and
other local services

Quality – are the activities proposed in line with good practice?
Cancer Council NSW Tackling Tobacco Regional Grant Application Form 2012-13
Section 1: Application Guide
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Cancer Council NSW Tackling Tobacco Regional Grant Application 2012-13
Section 2: Regional Smoking Care Grants Information
Application Assessment Committee
Members of Cancer Council NSW regional and tobacco control teams will assess applications. An
external member will also sit on the assessment panel.
Members of this committee will declare any conflict of interest and will exclude themselves from
discussions or decisions that may be affected by conflict of interest
Support and Resources
We encourage you to contact us with any questions you have about applying for a grant. Please
contact Kath Duggan in Hunter Region Office (contact details above)
Alternatively contact Cancer Council Tackling Tobacco program officer Philip Hull on:
email – philh@nswcc.org.au
Phone - 9334 1478
A range of short, readable resources that provide practical suggestions for community
organisations to address smoking are available on Cancer Council’s NSW’s Ask the Question
website. These include.
 Clearing the Smoke – Best Practice Smoking Cessation Strategies for People with Multiple
Disadvantages
 Addressing Smoking in Community Service Organisations – A Policy Toolkit
 Fact sheets on Smoking and Disadvantage and the Impacts of Smoking and the Benefits of
Quitting.
 Nicotine Replacement Therapy – Frequently Asked Questions.
Further resources are also available on the Tackling Tobacco program website, including useful
resources developed by other organisations.
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Section 1: Application Guide
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Section 3: Regional Grants Project Plan
Please respond in the boxes provided. Please feel free to expand the size of the box in either an
electronic or printed format if you need more space.
Name of your Organisation/Program:
Location

Hunter
Suburb ______________________________________________
Client Group

Homelessness

Mental health / illness

Drug and alcohol

Disadvantaged families

At risk youth

Aboriginal

Other disadvantage, please indicate
____________________________________________________________________
What are the main aims of your project?
Cancer Council NSW Tackling Tobacco Regional Grant Application Form 2012-13
Section 2: Project Plan
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Briefly outline your project (200 words or less)
Please note that elements of the project can easily be indicated by filling out the checkboxes and
outline plan on the following pages.
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Section 2: Project Plan
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Program elements
Please indicate what elements you intend to include in your project. If you are looking for
advice on suitable strategies, please refer to links and contact information on page 6.
Our Agency intends to
Please
Tick 
1) Option 1. Provide nicotine replacement therapy (NRT) for clients.
If this option is chosen, it is essential to nominate option a) below and at
least one option from b) to f). See our Frequently Asked Questions
document for detailed information on NRT and our cessation guide for
more information on how workers can support service users to quit.
a) Relevant staff will attend Smoking Care Training (essential
criterion). This training is provided free via Centre for Community
Welfare Training (CCWT).
b) Staff will ask clients regularly about their smoking.
c) Staff will provide one-on-one support in casework.
d) The service will facilitate a quit support group.
e) Staff will refer clients to external support e.g. Quitline.
f)
Other (please specify).
2) Option 2. Improve smoking-related policy.
If this option is chosen, it is a requirement to make changes to at
least one of these policy areas. See our policy toolkit for more details.
a) Review existing policy (essential criterion if applicable).
b) Become a smoke-free site.
c) Establish a designated smoking area for clients, or improve the
placement/design of a designated smoking area.
d) Establish designated smoking areas for staff.
e) Develop protocols on staff smoking, for example limiting smoking
to official breaks, or not allowing smoking with clients.
f)
Develop other areas of policy, for example: not smoking in
company vehicles; protecting staff from smoke on home visits; not
providing tobacco to clients; making a statement of principle that it
is a service priority to support clients to quit attempts.
g) Other.
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Section 2: Project Plan
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Project Plan:
Please provide a timeline for your project, including start and finish dates, key
activities and when they would occur. Please also indicate what activities you
could continue after the grant funds have been spent (for example, policy would
remain in place, staff ask clients about smoking and refer to relevant local
services). The timeline will include the milestones necessary to action the
elements you have ticked in Question 5.
Milestone
Timeframe/Due by date
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Section 2: Project Plan
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Your plan for distributing nicotine products (if this will be part of the project)
As organisations work in different ways, how you plan to distribute nicotine products will
vary. The following questions will help you to formulate a plan.
a. How will your clients access NRT?
 Directly from your organisation after being purchased from a supplier e.g. website,
wholesaler or local pharmacy
 Directly from a local pharmacy using an account set up by your organisation or to be
reimbursed by your organisation
 Another source, please specify …………………………..
b. Is there a safe place for the storage of NRT at your service (particularly if children attend)?
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Section 2: Project Plan
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Monitoring and Evaluation of Regional Grants Program
Evaluation
All funded projects will be required to collect some data in order to evaluate the project. To do
this Cancer Council NSW regional staff will carry out a short interview at the end of the project
with your project leader to find out things such as:

Whether clients were interested in receiving help to quit smoking

Whether support to quit smoking fitted with existing workloads

What barriers were encountered

What benefits clients experienced by quitting

Any adverse effects

What were the most useful/best aspects of the projects

What goods news stories came out of the projects

Any information that might be helpful to other services

How the process of introducing policy changes went.
The other written information that you will be required to provide is:
i.
Option 1. Quit smoking related data collection (if providing nicotine products)

Number of participants who received nicotine products through the grant

Number of clients who tried to quit

Number of clients who reported quitting or cutting down (with and without nicotine
products)

The proportion of people who managed to quit or cut down with nicotine products, and
the proportion who quit or cut down without nicotine products.
ii.
Option 2. Policy changes

A written record of the policy changes that were introduced (for example a copy of the old
and new policies and an outline of what changed)
Simple pro forma monitoring and evaluation sheets will be provided by Cancer Council NSW to
agencies to record this data.
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Section 2: Project Plan
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i.
Financial records
We will need a financial record of spending on nicotine products if this option is chosen, for
example receipts, or account records from a pharmacy.
We will need a financial record of spending on staff time related to policy development if this option
is chosen. For example, an invoice for the number of staff hours required at the relevant pay rate.
Please Note
The Family Services Grants project is being evaluated, so your co-operation in collecting data is
important in providing a good quality measurement of project outcomes. Signing the Terms and
Conditions of the funding will indicate you are agreeing to collect data.
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Section 2: Project Plan
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Terms and conditions of funding
If your application is successful, the following undertakings and conditions will form your
statement of commitment with Cancer Council NSW:
a. We agree that workers involved in providing support for clients to quit smoking will attend
relevant training.
b. We agree to use nicotine replacement specifically for clients and staff of our service.
c. We agree that we will recommend that clients consult a doctor about quitting smoking if they
take regular medications, in order to monitor any effects of a change in smoking status on
these medications. Please note that both smoking and quitting smoking can alter the level of
some medications in the blood, so medical monitoring is recommended as a precaution when
people who take medications change their smoking patterns.
d. We agree to use the funding for the approved purposes only and to seek approval from
Cancer Council NSW for any changes to the plan outlined in this application form.
e. We agree to report on the outcomes of the project for evaluation purposes as described
above.
f.
We acknowledge the right of Cancer Council NSW to terminate this Agreement if the
activities specified in this statement of commitment are not undertaken as agreed.
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Section 2: Project Plan
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We have read the above conditions and agree, if funded, to carry out the activities as
described in this application and according to this statement of commitment.
__________________________________________________
__________________
Signature of Contact person
Date
__________________________________________________
Name of Contact person
__________________________________________________
__________________
Signature of Executive Officer/Manager/President/Secretary
Date
__________________________________________________
Name of Executive Officer/Manager/President/Secretary
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Section 2: Project Plan
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Section 4: Regional Grant Project Administration
Applicant’s details
1) Name and Postal Address of Organisation:
2) Is the organisation “Incorporated” or under the auspice of an Incorporated organisation?
 Yes
 No
Please provide details of the auspicing organisation:
Organisation’s Name ______________________________________________________
Phone Number ___________________________________________________________
Address ________________________________________________________________
Contact Person __________________________________________________________
Position_________________________________________________________________
3) Is your agency a not-for-profit organisation?  Yes
 No
4) Does your organisation have an Australian Business Number (ABN)?
 Yes, the number is ______________________________
 No
Is the organisation registered for GST?
 Yes (please attach copy of your ‘GST Registration’)
Cancer Council NSW Tackling Tobacco Regional Grant Application Form
Section 3: The Smoking Care / NRT Intervention Project Administration
 No
p. 18
3) Contact person in your organisation who will be responsible for overall management of the
project
Name: ____________________________________________________________________
Position: __________________________________________________________________
Address (if different to above): _________________________________________________
Telephone: ___________________________
Fax: ____________________________
E-mail: ____________________________________________________________________
For Office Use Only:
Date grant application is received by Cancer Council NSW
Date grant application is approved
Please Note: The next page contains a pro forma invoice that can be used if convenient.
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Section 3: The Smoking Care / NRT Intervention Project Administration
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INVOICE
Tax Invoice Number:
Organisation
Name:
____________
Date:
Organisation Address:
Contact Person and
Telephone:
Email address:
To: Tobacco Control Unit, Cancer Council NSW, 153 Dowling St, Woolloomooloo NSW
2011
The Grant Approved is for
_______________________________________________________
_______________________________________________________
Total Cost
Suppliers Account attached
$
Yes 
(plus GST)
No 
Our organisation’s
Direct Bank Deposit Details are:
BSB
Account Number
Full Name of Account
Cancer Council NSW Tackling Tobacco Regional Grant Application Form
Section 3: The Smoking Care / NRT Intervention Project Administration
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