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Grant Application for Local Drug Free Communities
Funding Period is July 1, 2024 through December 31, 2024
Step
1
of
4
25%
Project Information
Organization Name
*
Project Name
*
Funding Amount Requested
*
Name of Agency Leader (President, CEO, Director, Captain)
Organization's Phone Number
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Contact Person
*
Contact Person's Phone Number
*
Contact Email Address
*
Not for Profit/501(c)3 Organization?
*
Yes
No
Federal ID Number
MCSAC Priority Problem Area Your Grant is Addressing, if any
Please check any or all that apply
Select All
Youth use of alcohol, tobacco, or other drugs
Adult use of of alcohol, tobacco, or other drugs
Adult Mental Health
Youth Mental Health
Other Problem Areas Your Grant is Addressing
List other areas your grant would address (if any)
Grant Category
*
Please only check one
Prevention
Treatment
Criminal Justice
The project is:
*
New
Existing
Total Cost of Project
*
Enter the total cost of this specific project (Note: this amount may be different than the amount that you are asking for from MCSAC)
Number of Individuals to Be Served
*
Male
Female
Primary age of individuals to be served:
*
Check all that apply.
Elementary School Youth
Middle School Youth
High School Youth
Young Adults (18-25)
Adults (26-55)
Adults (56 and up)
It is presumed that the intended recipients of the service will primarily consist of Morgan County residents. If this is not the case, provide clarification.
*
Project Overview
Describe Your Proposed Project:
*
From your perspective or that of your agency, what specific outcomes does the project aim to achieve in addressing the identified problem? Please provide detailed insights.
*
How will this project collaborate with other services and/or resources to ensure a quality project and avoid duplication?
*
Can your project be accomplished if only partial funding is available?
*
Yes
No
If yes, please explain:
If this is an existing program, please list all current funding sources and funding amounts:
List all Sources and Amounts. Click the + to add multiple
Funding Source
Amount
Identify any additional funding sources for the proposed grant project, including fund raising efforts:
*
List all Sources and Amounts. Click the + to add multiple
Funding Source
Amount
Detailed Budget Information
Please fill out the following questions as they pertain to the specific project you are applying for. If you do not have any money budgeted for a specific category, please indicate that in each area with a $0 or n/a. **There is an area to explain each expense category after all budget lines are completed.
Personnel Costs for This Project
*
Drug Free Community Funds
Other Funding
In-Kind
=Total
Travel
*
Drug Free Community Funds
Other Funding
In-Kind
=Total
Materials
*
Drug Free Community Funds
Other Funding
In-Kind
=Total
Equipment
*
Drug Free Community Funds
Other Funding
In-Kind
=Total
Other
*
Drug Free Community Funds
Other Funding
In-Kind
=Total
Please make sure to describe "Other" expenses below.
TOTAL BUDGET
*
Total costs of the project. (This should be the amount in each column after totaling all the expense categories above)
Drug Free Community Funds
Other Funding
In-Kind
=Total
Budget Notes
*
Provide detailed information on personnel costs and elaborate on the various expense categories mentioned earlier, including Personnel, Travel, Materials, Equipment, and Other.
Please Read the Following and Sign and Date
• I, the undersigned as the responsible party, do understand that I (my agency) may be contacted by Morgan County Substance Abuse Council about my application; • I understand that priority is given to county-wide programs and those programs addressing priority areas; • I understand that, if awarded funds for this grant cycle, monies will not be available for use until July 1, 2024 and that project expenditures incurred before that day will not be approved for funding; • I further understand that this original application is to be submitted electronically no later than 5:00 p.m. on April 3, 2024 for funding consideration. No applications will be accepted after this deadline. • I further understand that final reports will be due January 31, 2025. Grantees must turn in final invoices for reimbursement no later than December 31, 2024.
Signature
*
By typing your name in the field below you acknowledge that you have read the above information and completed this application truthfully and to the best of your knowledge.
Date
MM slash DD slash YYYY
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