Métis Counselling Connection (MCC) Program – Application Form

Applicant Information
Have you participated in the MCC program in the past?
If yes, submitting this application will indicate that you wish to be notified if the opportunity for additional funding arises. This information will be noted in our program records and does not guarantee that you will be contacted.
Are you a registered Citizen with MNBC?
If no, please re-apply once you receive your MNBC Citizenship Number.
Gender
The following question is completely optional. However, the information is valuable for MNBC and is confidential.
The MCC program may receive specific pockets of funding from other MNBC Ministries which could increase access for Citizens. If you are comfortable, please select all that may apply as to why you are seeking mental health services:
Do you have a service provider in mind?
If not, you may contact a Regional Mental Wellness Coordinator in your area at mentalwellnesscoordination@mnbc.ca, who can assist in finding a service provider and/or for further support navigating internal/external mental health services.
Application Agreements

As an applicant of the MCC program, I agree to the following:
  • My application will not be processed immediately, and it may take some time.
  • I will access mental health services in a timely manner, keeping waitlist realities in mind.
  • I will be aware and mindful that the MCC program will be sending out regular correspondence about the program and will ensure to keep up with that information.
  • I am responsible for ensuring that I remain within the funded amount. I will be mindful of any costs when receiving services or assessments from one or more service providers as I will be responsible for paying any amount above my funded limit.
  • All granted funds I may receive are ineligible for transfer to another individual (including family members).
Declaration of Truth and Consent

Declaration of Truth:
  • The applicant declares that all the information given in this application form is true and complete.
  • The applicant declares that the monthly income declared is factual and true (if applicable).
  • The Métis Citizen applicant(s) declares that they have not applied for First Nation status under Bill C31, Bill C-3, or Bill S-3 or any other government legislation. The MNBC Central Registry Office will periodically verify that grant recipients maintain MNBC Citizenship.
  • The applicant acknowledges and agrees that the facts given in this application form will be kept and disposed of as required by the Information Management Act.
  • The applicant agrees that MNBC may collect data and contact them from time to time for the purpose of conducting any client-related surveys.
  • The applicant(s) understands that this application does not obligate MNBC to approve funding.
  • All applicants who give personal information to MNBC shall be required to consent to the release of that information to MNBC to comply with the BC Personal Information Protection Act (PIPA) and Freedom of Information and Protection of Privacy Act (FIPPA).

Consent:
 
  • The applicant(s) gives consent to MNBC and its agents to investigate and disclose any of the information given in this application form for internal purposes or to other agencies for any of the following reasons:
    • To confirm household income;
    • To confirm eligibility for the program;
    • Audit purposes;
    • Referral to other programs within MNBC or outside service providers; and/or
    • To assist with MNBC research and publications.
  • The applicant(s) consents to release the information provided in this application to MNBC, and understands this information will be used in accordance with the BC Personal Information Protection Act (PIPA) and Freedom of Information and Protection of Privacy Act (FIPPA).