SCHC Mini Grant Application

 
Name of Group/Organization: *
Street Address - City State Zip:
Contact First Name: *
Contact Last Name: *
Contact Email Address: *
Contact Phone Number:
Event Location/s:
Target Population?
Requested Amount (Please check one)
$250 (serving 50 and under)
$500 (serving 50-75)
$1000 (serving over 100)
Proposed Activity/Event:
PLEASE EXPLAIN YOUR PROJECT BELOW IN 1500 WORDS OR LESS

Type of Event:
Potential number of people impacted:
What type of Prevention Message:
Will there be Evidence Based Program?
Yes
No
If Evidence Based, what type?
Do you need Prevention Materials?
Yes
No
Please check the types of Prevention Materials needed:
RX
Opioid
Drug
Alcohol
Vaping
Other
Other Prevention Materials Needed:
Target age of Potential people impacted?
Middle School
High School
Young Adults
Families
Would you like help connecting with technical assistance?
Yes
No
Would you like help connecting with Collaborative Partners?
Yes
No
Please include a budget for your project:
I agree to provide SCHC with a copy of all materials that is used for the event: * Agree

I agree to share the flyers of the event with SCHC prior to the event announcement: * Agree

I would like to attend the Developmental Asset Training Class provided by SCHC prior to the events?
Yes
No
Do you have any questions or comments to share?
By Clicking Submit Application, I agree that all the information provided is true and I am authority to request funds for the organization listed above.
 
 


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