Request for funding form

Group or individual seed funding request for meetings, special events, conferences/symposia and other


Please fill out the form below with as much detail as possible. The request will be forwarded to PHA Canada's Seed Grant Committee, who will assess the application based on feasibility and funds available. The more detail you provide the faster the Committee will be able to make the decision: if the Committee feels that there is not enough information provided they may request for you to provide additional information.

Please note that PHA Canada will require accounting to be done at year-end or event-end depending on the type of funding being requested. An accounting report (form will be provided) and receipts must be sent to PHA Canada. All remaining funds must either be returned to PHA Canada or will carry over into the following year's budget depending on type of funding.


Form items marked with * must be completed (the form will not submit if starred items are left blank)

 Support Group Meeting
 Special Event
 Meeting space
 Guest speakers
 Educational Materials
 PHA Canada special event t-shirts (up to 10 t-shirts may be requested for special events only, for volunteers or as prizes)
 Help with event promotion (flyers, mail-outs, etc.)
 Attendance/speaking at event by a PHA Canada representative
 Promotional goodies (wristbands, pins, etc.)
 PHA Canada display banner to be sent for use at my event
 Use of PHA Canada online event registration/donation pledging system for my event (available starting January 2011)
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