2011 Request for Applications (RFA) Hamilton County Family Services and Treatment Prevention Program Grant


 

2011 Request for Applications (RFA)

 

 

Hamilton County Family Services and Treatment

Prevention Program

 

 

Developed by:

Coalition for a Drug-Free Greater Cincinnati

2330 Victory Pkwy., Suite 703

Cincinnati, OH 45206

 

 

Important Dates:

Applications Due – November 18th, 2011

Awards Announced – December 1st, 2011

Midyear Reports Due – May 1st, 2012

Final Reports Due – November 30th, 2012



Table of Contents


 

I.        Executive Summary                                                                                

II.     Funding Opportunity Description

A.    Introduction

1.      Community Anti-Drug Coalitions

2.      Strategic Prevention Framework

3.      Environmental Prevention

B.      Grantee Expectations

1.       Performance Measurement Requirements

2.       Evaluation Requirements

3.       County Meeting Requirements

 

III.   Award Information

 

IV.  Eligibility Requirements

 

V.     Application and Submission Information

A.    Submission Deadline

B.      Other Submission Requirements

C.     Evaluation Criteria

D.    General Instructions

E.      Outline of Grant Application

 

VI.  Award Administration Information

A.    Award Notices

B.      Administrative Requirements

C.     Reporting Requirements

 

VII.      Coalition Contacts

 

VIII.   Attachments

A.    Cover Sheet

B.      Sector Table Template

C.     One-year Action Plan Template

D.    One-year Budget and Budget Narrative Template

 

 

I.       Executive Summary

 

The Coalition for a Drug-Free Greater Cincinnati (CDFGC) announces the availability of funds for new FY 2011-2012 Hamilton County Family Services and Treatment – Prevention Program grants.

 

Funding Opportunity Title:                           Hamilton County Family Services and Treatment – Prevention Program

 

Due Date for Applications:                           November 18th, 2011

 

Anticipated Total Available Funding:          $15,000 (There is no match required for this grant)

 

Estimated Number of Awards:                     Minimum of 3

 

Estimated Individual Award Amount:        Up to $5,000

 

Length of Project Period:                               One Year

                                                                       

Eligible Applicants:                                        The application must be submitted by a community-based coalition. (See Section IV, page 10)

 


 

II.    Funding Opportunity Description

 

A.    Introduction

 

The Hamilton County Mental Health Recovery Services Board (HCMHRSB) has contracted with the Coalition for a Drug-Free Greater Cincinnati to support local coalition development in Hamilton County.

 

The goals of the Hamilton County Family Services and Treatment – Prevention Program are to:

 

Goal 1: Establish and strengthen collaboration among community sectors and county entities to support the efforts of community coalitions to prevent and reduce substance abuse among youth.*

*youth is defined as individuals 18 and younger.

 

Goal 2: Reduce substance abuse among youth and, over time, among adults by addressing the factors in the community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse.*

*substances include, but are not limited to, narcotics, depressants, stimulants, hallucinogens, cannabis, inhalants, alcohol, and tobacco, where their use is prohibited by federal, state, or local law.

 

Grantees are required to work toward these two goals as the primary focus of their county funded effort.

 

1.       Background on Community Anti-Drug Coalitions

 

Grants awarded through the Hamilton County Family Services and Treatment – Prevention Program are intended to support community-based anti-drug coalitions. For the purposes of this Request for Applications (RFA), a coalition is defined as a formal arrangement for cooperation and collaboration between groups or sectors of a community, in which each group retains its identity, but all agree to work together toward a common goal of building a safe, healthy, and drug-free community.

 

Coalitions have and need deep connections to the local community and they serve as catalysts for change in their community.  Coalitions must work hard to connect with their community members on a grassroots level and accept that coalition building takes time and effort. Coalition building, collaborative problem solving, and community development are some of the most effective interventions for change available today[1].

 

Coalitions receiving Hamilton County funds are expected to work within their defined community to identify and address local substance abuse problems. Coalitions should engage local leaders and community residents in an ongoing effort to better understand local challenges and to generate lasting change in the community.

 

Coalitions are expected to develop and utilize environmental strategies based on a community systems perspective that views a community as a set of persons engaged in shared social, cultural, political, and economic processes. Environmental strategies are based on the belief that substance abuse is a product of multiple environmental conditions and circumstances. These include the rules and regulations of the social institutions to which individuals belong, the norms of the communities in which they live, the mass media messages to which they are exposed, and the accessibility of alcohol, tobacco, and other drugs. Therefore, effective prevention requires “intervention” in various facets of community life that are designed to change individuals and the environment in which they live.

 

Coalitions must clearly define and understand the unique characteristics of the communities they seek to serve. The intended community of focus must encompass a geographic area defined by the applicant and must be within the boundaries of Hamilton County, Ohio and serve Hamilton County residents only. Grantees may not serve the same zip codes unless there is written evidence of cooperation between the overlapping coalitions.

 

More information on community anti-drug coalitions can be found at www.drugfreecincinnati.org

 

2.      Background on the Strategic Prevention Framework

 

The Strategic Prevention Framework (SPF), developed by the federal Substance Abuse and Mental Health Services Administration (SAMHSA), assists communities to develop the infrastructure needed for a community-based, public health approach leading to effective and sustainable reductions in alcohol, tobacco, and other drug (ATOD) use and abuse.

 

The five elements that make up the SPF include:

 

Assessment: Collect data to define problems, resources, and readiness within a geographic area to address needs and gaps. The assessment phase helps define the problem or the issue that a coalition needs to tackle. This phase involves the collection of data to:

·         Understand a population's needs

·         Review the resources that are required and available

·         Identify the readiness of the community to address prevention needs and service gaps

Communities will organize a workgroup to collect the necessary data. The data gathered from this workgroup is vital because it will greatly influence a coalition's strategic plan and funding decisions.

 

Capacity: Mobilize and/or build capacity within a geographic area to address needs.

Capacity building involves mobilizing human, organizational, and financial resources to meet intended goals. Training and education to promote readiness are also critical aspects of building capacity. Extensive training and technical assistance (TA) may be necessary to fill readiness gaps and facilitate the adoption of science-based prevention policies, programs, and practices.

 

Planning: Develop a comprehensive strategic plan that includes policies, programs, and practices creating a logical, data-driven plan to address problems identified in Step 1.

Planning involves the creation of a comprehensive plan with goals, objectives, and strategies aimed at meeting the substance abuse prevention needs of the community. During this phase, coalitions develop logic models and select evidence-based policies and programs. They also determine costs and resources needed for effective implementation.

 

Implementation: Implement evidence-based prevention programs, policies, and practices. The implementation phase of the SPF process is focused on carrying out the various components of the comprehensive prevention plan, as well as identifying and overcoming any potential barriers. During implementation, coalitions detail the evidence-based policies and practices that need to be undertaken, develop specific timelines, and decide on ongoing evaluation needs.

 

Evaluation. Measure the impact of the SPF and the implemented programs, policies, and practices. Evaluation helps coalitions recognize what they have done well and what areas need improvement. The process of evaluation involves measuring the impact of programs and practices to understand their effectiveness and any need for change. Evaluation efforts therefore greatly influence the future planning of a coalition. It can also impact sustainability, because evaluation can show sponsors that resources are being used wisely.

 

Additionally, Sustainability and Cultural Competence have been added to the core of the framework as both are necessary in developing an effective coalition[2].

 

More information on the Strategic Prevention Framework can be found at www.drugfreecincinnati.org


 

3.       Background on Environmental Prevention

 

Because coalitions work to reduce rates of tobacco, alcohol, and drug use for entire communities they necessarily employ a broad array of strategies to meet these objectives. For each objective a coalition sets, any or all of the following environmental prevention strategies may be used. Typically, individual organizations implement one or only a few of these strategies:

 

1.      Provide Information - Educational presentations, workshops or seminars or other presentations of data (e.g., public announcements, brochures, billboards, community meetings, forums, web-based communication)

2.      Enhance Skills - Workshops, seminars, webinars, or other activities designed to increase the skills of participants, members and staff needed to achieve population level outcomes (e.g., training, technical assistance, distance learning, strategic planning retreats, curricula development)

3.      Provide Support - Creating opportunities to support people to participate in activities that reduce risk or enhance protection (e.g., providing alternative activities, mentoring, referrals, support groups, or clubs)

4.      Enhancing Access/Reducing Barriers - Improving systems and processes to increase the ease, ability, and opportunity to utilize those systems and services (e.g., time, distance, assuring healthcare, childcare, transportation, housing, justice, education, safety, special needs, cultural and language sensitivity)

5.      Changing Consequences (Incentives/Disincentives) - Increasing or decreasing the probability of a specific behavior that reduces risk or enhances protection by altering the consequences for performing that behavior (e.g., increasing public recognition for deserved behavior, individual and business rewards, taxes, citations, fines, revocations/loss of privileges)

6.      Change the Physical Design of the Environment - Changing the physical design or structure of the environment to reduce risk or enhance protection (e.g., parks, landscapes, signage, lighting, outlet density)

7.      Modifying Policies and Broader Systems - Formal change in written procedures, by-laws, proclamations, rules or laws with written documentation and/or voting procedures (e.g., workplace initiatives, law enforcement procedures and practices, public policy actions, systems change within government, communities, and organizations)

 

More information on Environmental Prevention can be found at www.drugfreecincinnati.org


B.     Grantee Expectations

 

1.       Performance Measurement Requirements

 

The Coalition for a Drug-Free Greater Cincinnati is required to set program performance baselines and targets and to report annually on the degree to which the annual targets were met. All grantees are required to provide data on the following core measures for the coalition’s entire catchment area:

·         Age of onset of any drug use (including alcohol, marijuana, and tobacco)

·         Frequency of use in the past 30 days (including alcohol, marijuana, and tobacco)

·         Perception of risk or harm (including alcohol, marijuana, and tobacco)

·         Perception parental disapproval (including alcohol, marijuana, and tobacco)

 

The terms and conditions of the grant award will specify how the data is to be submitted and the schedule for submission of data using a common tracking/monitoring system.

 

More information on the Four Core Measures can be found at www.drugfreecincinnati.org

 

2.       Evaluation Requirements

 

Grantees are required to utilize a common tracking/monitoring system. Funded coalitions will be required to track:

·         Coalition accomplishments including community changes, services provided, media, and resources generated

·         Coalition capacity-building including organizational change, training, technical assistance, and planning products

·         Key community indicators including the four core measures, consequence data, and other social indicators

 

Grantees are also required to participate in the CDFGC’s Coalition Development Inventory (CDI) which is intended to measure the progress and the development of the coalitions in the region.

 

More information on Coalition Evaluation can be found at www.drugfreecincinnati.org

 

3.       County Meeting Requirements

 

Successful applicants funded through this RFA are required to send two people to a one-day New Grantee Meeting/Training in the first year of the grant award.  Additionally, all applicants must plan to send one representative to periodic meetings and trainings as scheduled. The CDFGC will notify grantees and provide details for mandatory trainings as far in advance as possible. These Hamilton County-based trainings will be offered at no cost to the grantee.

III. Award Information

 

Approximately $15,000 total, for a minimum of three FY 2011 Hamilton County Family Services and Treatment – Prevention Program grants, will be awarded through this RFA. Grants will be available to eligible communities & coalitions in amounts of up to $5,000 on an annual basis. 

           

Applicants may request up to $5,000 per year for the funding cycle. If selected to receive a Hamilton County Family Services and Treatment - Prevention Program grant, coalitions will be awarded funds for one year (covering the 12-month period from December 1st, 2011 – November 30th, 2012). Funds for subsequent years are distributed on an annual basis as new, competing awards. Annual awards are contingent upon the availability of Hamilton County Family Services and Treatment – Prevention Program funds, the continued ability of the coalition to demonstrate eligibility, grantee progress in meeting grant requirements, and timely submission of the continuation application, as well as all required data and reports.

 

There is no match required for this grant.

 


IV. Eligibility Requirements

 

The Hamilton County Family Services and Treatment tax levy of 2009, authorizes grant funding for community coalitions in Hamilton County. The eligibility criteria are outlined below.  Applications submitted that do not demonstrate that they meet the eligibility requirements will not advance to the review stage.

 

 

Eligibility Requirement Item(s):

How to Document:

Requirement 1:

The coalition must have as its principal mission the prevention and reduction of youth substance abuse.

Applicants must provide a copy of the coalition’s mission statement.

 

Requirement 2:

The coalition must consist of 1 or more representatives of each of the following sector categories:

1.   Youth (18 or younger)

2.   Parents

3.   Businesses

4.   Media

5.   Schools

6.   Youth-serving organizations

7.   Law enforcement

8.   Religious or faith-based organizations

9.   Civic or volunteer groups

10.     Health care professionals

11.     Local governmental agencies with    expertise in the field of substance abuse

12.     Other organizations involved in reducing substance abuse

 

Coalition members may only serve as a representative of one sector at a time.

In table format, applicant must list:

1.   The identified 12 sector category

2.   The coalition member(s)/person(s) representing that sector

3.   The name of the organization represented by the that individual for each sector

4.   Describe how the individual and the organization in each sector contribute to the coalition’s activities.

(Use table in Attachment B, page 21)

 

 


 

Requirement 3:

The coalition must demonstrate ability to manage fiscal responsibilities.

Applicants must attach a copy of the 501(c)3 status letter from the IRS. If the applicant is not a 501(c)3 organization, a fiscal agent must be used and a copy of the fiscal agent’s 501(c)3 letter must be included.

Requirement 4:

The applicant must not request more than $5,000 in county funds.

Add all budget categories in One-year Budget and Budget Narrative

(Use table in Attachment D, page 23)

Requirement 5:

Coalitions must serve communities and their residents within Hamilton County. Communities may not be served by more than one coalition. Zip codes may not overlap unless there is a clearly described plan for collaboration in their applications and each coalition has independently met the eligibility requirements.

Applicants must identify the zip codes to be served.  If there is an overlap of zip codes, the applicant coalition must also include a letter of cooperation from the overlapping coalition that clearly describes their plan for collaboration. Place the letter of cooperation attachment in the Eligibility section of your application, if applicable.

 


V.    Application and Submission Information

 

A.    Submission Deadline

 

Applications must be received via email or mail by 4:30 p.m., Friday, November 18th, 2011.  The CDFGC will not accept applications set by facsimile.

 

Coalition for a Drug-Free Greater Cincinnati

2330 Victory Pkwy., Suite 703

Cincinnati, OH 45206

Phone:  513-751-8000

Attn: Kellie Kammer, Administrative Assistant

kkammer@drugfreecincinnati.org

 

B.     Other Submission Requirements

 

Formatting requirements

 

Applicants that do not comply with the following requirements will not be considered for funding: 

  • Text must be typed in black ink, single-spaced with one column per page
  • Font of Times New Roman 12, with all margins (left, right, top, bottom) at least one inch each
  • Pages should not have printing on both sides
  • Paper must be white and 8.5 by 11.0 inches in size
  • Pages should be numbered consecutively from beginning to end following the required outline
  • Any attachments, other than those required, will not be considered for review

 

C.     Evaluation Criteria

 

General instructions for completing the RFA are provided below. In addition to following these instructions, be sure to carefully read and respond to the guidance, questions, and instructions that pertain to each individual section.

 

D.    General Instructions

 

There are a series of questions and topics that you must address in written narrative form. The information and responses you provide in these sections form the “Project Narrative” portion of your application. If you meet the eligibility requirements, your Project Narrative


will be evaluated and scored. In developing the Project Narrative section of your application you MUST use the instructions outlined below, which have been tailored to this program.

 

·         Your Project Narrative may be no longer than six (6) pages total.

·         You MUST respond to every question in each category of the Project Narrative, individually.

·         Your Project Narrative will be scored according to how well you answer the questions and respond to the request in each section.

·         Coalitions should assess the substance abuse problems in their community and also factor in the connection between culture and diversity in formulating appropriate and effective responses to local substance abuse problems. Guidelines for addressing cultural competence for coalitions can be found on CDFGC’s website under Coalition Toolbox.

·         You MUST provide a detailed Budget and Budget Narrative using the sample budget template provided in the attachments of this RFA.

·         There is no page limit for the One-year Budget and Budget Narrative section; however, you must use the table provided in Attachment D, page 23.

·         The Budget will be scored based on the information you provide in your Budget and Budget Narrative.

·         You are asked to provide Supporting Documentation for various components of your application. Please read each section carefully and provide all of the requested information. Supporting Documentation should be included as an appendices to your application and be clearly and individually marked.

·         The Supporting Documentation is used to determine whether your application meets the eligibility criteria. They are critical in your application’s ability to move from eligibility screening to final review.

 

E.      Outline of Grant Application

 

Applications must follow this outline order when compiling your application. Each section, and the required information for each, is detailed below.

 

1.       Cover Sheet (Attachment A, page 20)

2.       Community Overview (scored)

3.       Project Narrative (scored)

4.       Budget (scored) (Attachment D, page 23)

5.       Supporting Documentation

a.      Eligibility Requirements

                                                        i.      Sector Table (Attachment B, page 21)

                                                      ii.      Financial Responsibility Documentation

                                                    iii.      Community and Zip Code Documentation

b.      Other Attachments (Non-scored)

 

 

1.      Cover Sheet (Attachment A, page 20)

The first page of your application is the Cover Sheet. See Attachment A, page 20, for the template.

 

2.      Community Overview

Include a brief description of your community of focus, limit to ONE page. The Community Overview is scored, but does not count toward your six (6) page limit. Include the following information in your description.

·         Paint a picture of your community. Describe for someone who does not know your community, what it is like to live, work, go to school, and recreate in your neighborhood. Provide a historical perspective and any significant key events.

·         Provide relevant demographic and census data for your community of focus (include a breakdown of age, race, ethnicity, gender, sexual orientation, religion, and socioeconomic status, as applicable). Describe the culture of your neighborhood and the people who live there. Provide the total population and the total number of students enrolled in grades seven (7) through twelve (12) in the specific schools and/or districts that are within your neighborhood.

·         Provide the geographic setting and specific geographic boundaries of your coalition’s community of focus.

 

3.      Project Narrative

There are two (2) types of Hamilton County Family Services and Treatment - Prevention Program grants available:  Planning and Implementation.  All types of grant applications must follow the same outline.  Applicant coalitions may apply for only one type of grant and must complete the appropriate narrative questions for the type of grant for which they are applying.

 

Planning Project Narrative Questions

 

1.      What is your community’s primary youth substance use-related problem(s)? How do you know that this/these are a problem? Responses should address, but are not limited to, the following:

a.      Youth substance use data/trends (i.e. PRIDE Data)

b.      Data related to youth consequences (i.e., social indicators) such as crime data, juvenile justice/social services referrals, school failure, impaired driving rates, emergency room data, substance abuse treatment admissions, teen pregnancy rates, and dating violence and sexual assault statistics

2.      What factors are contributing to your community’s youth substance use-related problems?


 

3.      What resources are available in your community to address youth substance use?

4.      How has your coalition mobilized your community to respond to the identified youth substance use issues?  Responses should address, but are not limited to, the following:

a.      Brief coalition history

b.      Coalition’s mission and vision

5.      How has the coalition used data to inform and mobilize the community?

6.      Describe your community partners and volunteer’s your coalition has convened to address youth substance abuse issues in your community and how they contribute to the work of the coalition.

7.      Describe how your coalition will utilize mini-grant funding to solidify the strategic planning process (coalitions will be responsible for submitting a completed needs assessment, logic models, strategic plans, an organizational chart, and revised sector table by November 30th, 2012):

a.      The completion of a community needs assessment

b.      The development of a logic model and strategic plan

c.       The development of an organizational structure to support the plan

d.      The development of communication strategies about the coalition and a plan to execute communication strategies

8.      What is your plan for bringing the community together to address substance abuse in your community?  Provide the coalition’s One-Year Action Plan in table format for the first year of funding (Attachment C, page 22).

9.      What key environmental strategies will the coalition employ to create community change?

10.  Describe the process your coalition used to address the priority youth substance use issues in your community.  Responses should address, but are not limited to, the following:

a.      Coalition members’ involvement in planning

b.      Community participation (beyond coalition membership)

c.       Use of data and current research

d.      Prioritization process for determining what to address and in what order

11.  How will your coalition track, monitor and report progress in the levels of effort and effectiveness to demonstrate outcomes from the action plan and coalition development?

 


 

Implementation Project Narrative

 

1.      What is your community’s primary youth substance use-related problem(s)? How do you know that this/these are a problem? Responses should address, but are not limited to, the following:

a.      Youth substance use data/trends (i.e. PRIDE Data)

b.      Data related to youth consequences (i.e., social indicators) such as crime data, juvenile justice/social services referrals, school failure, impaired driving rates, emergency room data, substance abuse treatment admissions, teen pregnancy rates, and dating violence and sexual assault statistics

2.      What factors are contributing to your community’s youth substance use-related problems?

3.      What resources are available in your community to address youth substance use?

4.      How has your coalition mobilized your community to respond to the identified youth substance use issues?  Responses should address, but are not limited to, the following:

a.      Brief coalition history

b.      Coalition’s mission and vision

5.      Describe your community partners and volunteers your coalition has convened to address youth substance abuse issues in your community and how they contribute to the work of the coalition.

6.      How is your coalition organized to get its work done?  Responses should address, but are not limited to, the following:

a.      Structure

b.      Leadership

c.       Decision Making

7.      Describe your internal and external communication mechanisms.

8.      What is your plan for bringing the community together to address youth substance use in your community?  Provide the coalition’s One-Year Action Plan in table format for the first year of funding (Attachment C, page 22).

9.      Describe the objectives and strategies your coalition has identified to address:

a.      Goal 1: to increase community collaboration, and

b.      Goal 2: to reduce youth substance abuse.

10.  What is the coalition’s formal monitoring mechanism for ensuring effective implementation?  Responses should address, but are not limited to, the following:

a.      Routine monitoring of the Action Plan by coalition members

b.      Tracking processes and procedures

c.       Keeping coalition members and the community informed of progress

11.  How will trends in community data be monitored to determine the coalition’s impact on the identified problems?

 

4.      Budget

All applicants must provide a one-year budget and budget narrative using the budget table included in Appendix D, page 23.

                                       

Unallowable expenditures

·         Award dinners & fundraising events

·         Capital construction or improvement

·         Operating/indirect expenses such as utilities, rent, etc.

·         Salaries, including consultants

·         Religious organizations for religious purposes

·         Political causes, candidates, organizations or campaigns

·         Grants to individuals

·         Food beverages over $500

·         Debt retirement

·         Alternative school activities (i.e. after prom parties)

 

Allowable expenditures

·         Evidence-based prevention programming and/or training

·         Supplies/photocopying/postage & mailing

·         Marketing/promotion cost for the specific project

·         Local travel

·         Food/beverages up to $500

·         Planning retreats

 

5.      Supporting Documentation

 

A.    Eligibility Requirements

a.       Sector Table (Attachment B, page 21)

b.      Financial Responsibility Documentation

c.       Community and Zip Code documentation

B.      Other Attachments (Non-scored)

 


VI. Award Administrative Information

 

A.    Award Notices

 

Within five (5) days of receipt of your application, CDFGC will notify you through email that your application has been received.

 

By December 1st, 2011, the list of awardees will be posted to www.drugfreecincinnati.org/HCFST/. Soon after, if you are approved for funding, you will receive a Notice of Award (NOA), signed by the CDFGC.  The NOA is the sole obligating document that allows the grantee to receive the county funding for work on the grant project.

 

All applicants that are reviewed will receive a letter from the CDFGC through U.S. Postal Mail that contains their review score and summarized comments from the reviewers.

 

B.     Administrative Requirements

 

Grantees must comply with all terms and conditions of the grant award. HCFST standard terms and conditions are available at www.drugfreecincinnati.org/HCFST.

 

Grantees will be held accountable for the information provided in the application relating to performance targets.  Failure to meet stated requirements or goals and objectives may result in suspension or termination of the grant award or in reduction or withholding of payments.

 

C.     Reporting Requirements

 

Each year, grantees are required to submit 2 reports (mid-year and final) that demonstrate progress towards goals 1 and 2 listed on page 4. 

 


VII.    Coalition Contacts

 

For questions regarding all prevention program and coalition related issues, including those pertaining to the completion of an application for this grant program, contact:

 

Tommy Koopman

Manager of Local Coalition Development

Coalition for a Drug-Free Greater Cincinnati

2330 Victory Parkway, Suite 703

Cincinnati, OH 45206

(513)751-8000 x14

tkoopman@drugfreecincinnati.org

 

 

 


Attachment A - Cover Sheet Template

Hamilton County Family Services and Treatment

Prevention Program

Applicant Information

Application (check one)

Type (check one)

Date Received*

*for office use only

 New

 Previously Funded

Planning (limit 2 years )

Implementation (limit 1 year)

Coalition Name

 

Street Address

 

City

State

Zip Code

County

Phone

Fax

Email

Zip Codes of coalition geographic area

Coalition contact

 

Title

Coalition contact signature

 

Date

EIN number

 

Fiscal agent (if applicable)

 

Title

Fiscal agent signature (if applicable)

 

Date

Application Checklist

Has your application complied with all eligibility requirements?

Does the application address the two HCFST Prevention Program goals?

Does your application include the coalition’s Mission Statement?

Does your application list the 12 community sectors?

Does your application include a copy of 501c3 status or that of its fiscal agent?

Is your Project Narrative no longer than 6 pages combined?

Does your Project Narrative answer each question asked for your specific grant application?

Have you included a one year budget with your application?

Have you listed only the specific zip code areas in which your coalition will work to impact
      substance abuse trends and problems?

Have you adhered to all submission requirements?

           


Attachment B - Sector Representation Sample Template

 


SECTOR

NAME

TITLE/

ORGANIZATION

SUMMARY OF CONTRIBUTIONS

YOUTH

Ex: Sam Senior

Senior, City Public HS

Serves as President of Student Congress.

PARENTS

 

 

 

BUSINESS COMMUNITY

 

 

 

MEDIA

 

 

 

SCHOOLS

 

 

 

YOUTH-SERVING ORGANIZATIONS

 

 

 

LAW ENFORCEMENT AGENCIES

 

 

 

RELIGIOUS OR FRATERNAL ORGANIZATIONS

 

 

 

CIVIC AND VOLUNTEER GROUPS

 

 

 

HEALTHCARE PROFESSIONALS

 

 

 

STATE, LOCAL GOVERNMENTAL AGENCIES WITH EXPERTISE IN THE FIELD OF SUBSTANCE ABUSE

 

 

 

OTHER ORGANIZATIONS

 

 

 

 


Attachment C – One-Year Action Plan

 

One-Year Action Plan

 

Timeline

Action Steps

Person/s Responsible

Resources Needed

December

 

 

 

January

 

 

 

February

 

 

 

March

 

 

 

April

 

 

 

May

 

 

 

June

 

 

 

July

 

 

 

August

 

 

 

September

 

 

 

October

 

 

 

November

 

 

 

 


 

Attachment D - One-Year Budget and Budget Narrative

 

One-year Budget and Budget Narrative

Budget Category:

Request:

 

Rate:

 

Total Requested:

 

Narrative:

 

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Total Requested:

 

Narrative:

 

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Total Requested:

 

Narrative:

 

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Total Requested:

 

Narrative:

 

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Request:

 

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Total Requested:

 

Narrative:

 

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Total Requested:

 

Narrative:

 

Budget Category:

Request:

 

Rate:

 

Total Requested:

 

Narrative:

 

TOTAL AMOUNT REQUESTED

(Not to exceed $5,000)                                                                                

$

 

 



[1] Source: Excerpt from “Handbook for Community Anti-Drug Coalitions”, CADCA (Community Anti-Drug Coalitions of America), 2005

[2] Substance Abuse Mental Health and Services Administration (SAMHSA)

 

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