Community Wellness Grants

Application for the Lucas County MHRSB Community Wellness Grants. Grant period: July 1, 2026 – December 31, 2026. All fields marked with an asterisk are required.

Budget form template

Download and complete the MHRSB budget form, then save or export it as a PDF before uploading it in the Required Documents section.

Download budget form template

Before you begin

Grant period: July 1, 2026 – December 31, 2026.

For technical assistance completing this application, contact:
Robert Kasprzak, Manager of Community Engagement
Phone: 419-213-4240
Email: [email protected]

Organization Information

Organization Name *

Authorized Contract Signer (Name and Title) *

Please enter the full name and official title of the person authorized to sign the grant contract on behalf of your agency (e.g., Jane Doe, Executive Director).

First name

Last name

Authorized Signer Email Address *

Direct email address for the authorized signer.

Authorized Signer Phone Number *

Direct phone number (including extension, if applicable) for the authorized signer.

Primary Contact Name

Complete only if the primary contact differs from the Executive Director.

First name

Last name

Primary Contact Email Address

Street Address *

Address Line 2

City *

State / Province *

ZIP / Postal Code *

Organization Phone Number *

Certification & Eligibility

Is your organization/agency certified by the Ohio Department of Behavioral Health (OhioDBH)? *

YesNo

Important

Important: OhioDBH-certified agencies are NOT eligible for this grant cycle and should not submit an application.

Is your organization/company a registered MBE, EDGE certified, or Minority Led? *

YesNo

Is your organization currently a registered vendor with Lucas County? *

YesNo

Has your organization previously received a grant award from MHRSB of Lucas County? *

YesNo

I confirm that our organization is registered as a nonprofit with the State of Ohio. I understand that only Ohio-registered nonprofits are eligible for this grant. *

Anticipated Project Start Date *

Use mm/dd/yyyy.

Anticipated Project End Date *

Use mm/dd/yyyy.

Executive Summary

Executive Summary *

Response limit: 400 words maximum.

Organizational Description

Relevant Organizational History *

Response limit: 400 words maximum.

Board of Directors *

List all board members — include Name and Title for each member. Example: Jane Smith, Board Chair

Organization's Primary Funding Sources *

Response limit: 400 words maximum.

Has this organization previously been funded by MHRSB? *

YesNo

Current Services Offered *

Response limit: 400 words maximum.

Problem, Opportunity, or Need

Community Need *

Response limit: 400 words maximum.

Primary ZIP Codes Served *

Please list no more than 5 ZIP codes.

Project Proposal

Project Name *

Provide the name of the proposed project.

Program Summary *

Response limit: 400 words maximum.

Project Scope & Process — What service will be provided? *

Response limit: 400 words maximum.

Target Population — Who is the target population? *

Response limit: 400 words maximum.

Vulnerable populations served

Mental Health & Substance Use Impact (if applicable) *

Response limit: 400 words maximum.

Awareness, Prevention & Education (if applicable) *

Describe any awareness campaigns, prevention strategies, or educational components included in your project. (400-word maximum).

Project Start Date *

Use mm/dd/yyyy.

Project End Date *

Use mm/dd/yyyy.

Participant Recruitment *

Response limit: 400 words maximum.

Is this program ongoing and expected to continue beyond MHRSB funding? *

YesNo

Is this a one-time project? *

YesNo

Is this an annual or recurring project? *

YesNo

Past Program Success

Response limit: 400 words maximum.

Evaluation Plan

Problem Your Service / Project Will Address *

Response limit: 400 words maximum.

Anticipated Number of People to be Served by Project *

Project Goals & Expectations *

Response limit: 400 words maximum.

Outcome Measurement *

Response limit: 400 words maximum.

Budget

Budget Form Instructions

Complete the official MHRSB Budget Form provided with the grant materials. Save or export the completed form as a PDF before uploading it in the Required Documents section below.

Revenue section: enter all sources of revenue for the proposed program. For MHRSB grant revenue, use the proposed MHRSB funding amount.

Personnel: include direct program staff salaries, supervision and support salaries directly attributed to the project, and employer fringe and tax costs — health, dental, and life insurance, employer FICA, unemployment, and workers’ compensation. Enter total FTE where the budget form requests it.

Program expenses: include non-personnel costs specific to the program, such as manuals, local travel and vehicle costs, outreach material, advertising, participant incentives, and other program-specific costs.

Operating expenses: include non-personnel costs related to overall business operations used by the program, such as rent, telephone, utilities, copier expense, office supplies, postage, agency insurance, staff training, and equipment rental.

Administrative overhead: include personnel-related administrative costs allocated to the program, such as executive director, HR, and fiscal staff, plus audit and financial review costs. Administrative overhead should not exceed 15% of total program expenses.

Cost per client served: once the number of clients served is entered in the budget form, cost per client served is calculated automatically.

Budget narratives: submit a separate budget narrative describing line items for both revenue and expense categories. If operating or administrative overhead is allocated to programs, describe the allocation method — for example FTE, personnel cost, or square footage. A budget is not complete without an accompanying budget narrative.

Eligibility note: this grant is intended for organizations with an annual organizational budget under $750,000. By submitting this application, the applicant confirms the organization meets this requirement.

Note

Note: This grant is intended for organizations with an annual organizational budget under $750,000. By submitting this application, you confirm your organization meets this requirement.

Grant Fund Acknowledgements

I understand grant funds may be used for direct program expenses or reimbursement of allowable costs incurred in the grant period. Expenditures must be documented and submitted per MHRSB guidelines. *

I understand that MHRSB does not expect funded organizations to provide direct mental health or addiction treatment services as part of this grant. *

I understand that grant award checks will be issued in the registered organization name only. *

I understand that this grant is intended for organizations with an annual budget under $750,000 per year. *

Required Documents

About uploads

All uploaded documents must be PDF files. Each file may be up to 10 MB, and all uploads together may total up to 25 MB per submission. If your budget form or other materials are in Word or Excel, export or save them as a PDF before uploading.

Upload Budget Narrative *

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Upload Completed MHRSB Budget Form *

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Upload IRS Form W-9 *

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Upload Proof of State of Ohio Nonprofit / Tax-Exempt Status

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Additional Information & Submission

How Did You Hear About This Grant? *

Link to Organizational Website or Social Media

I confirm that all information provided in this application is accurate and complete. I understand that misrepresentation may result in disqualification or grant revocation. *

Need help?

Questions about this application? Technical assistance is available from:
Robert Kasprzak, Manager of Community Engagement
Phone: 419-213-4240
Email: [email protected]

Before you apply — common questions

Anchor-linked answers to the eligibility and fiscal-sponsor questions we hear most often. Use the Copy link affordance on any question to share it directly.