Individual Application General Information FOR OFFICE USE ONLY Date & Time Received: Name: School: Telephone Number: Name of adult sponsor if applicant is a Title: Telephone Number minor Address: City: State: Zip: Fax: E-mail: Amount Requested: Estimated Number of Individuals to be Served: Ages of Individuals to be Served: If applicable, please indicate the type Student Group School Club of group or organization you School Faith-based Group represent: Non-profit Organization Government Agency Community Group College/University Service Club Other (please describe): Please check at least one of the four priority areas you are targeting: Reduce marijuana use among youth 12-20 years old. Reduce AOD use among non-traditional students (ex. alternative schools). Reduce painkiller use among youth 12-20 years old. Reduce alcohol use by 12-20 years old. Name of Project: Briefly describe yourself. MINI-GRANT APPLICATION NARRATIVE (DO NOT EXCEED 3 PAGES) 1. Describe your project and how it will benefit youth in your community.
Individual Application General Information FOR OFFICE USE ONLY Date & Time Received: Name: School: Telephone Number: Name of adult sponsor if applicant is a minor Title: Telephone Number Address: City: State: Zip: Fax: E-mail: Amount Requested: Estimated Number of Individuals to be Served: Ages of Individuals to be Served: If applicable, please indicate the type of group or organization you represent: Student Group School Non-profit Organization Community Group Service Club School Club Faith-based Group Government Agency College/University Other (please describe): Please check at least one of the four priority areas you are targeting: Reduce marijuana use among youth 12-20 years old. Reduce AOD use among non-traditional students (ex. alternative schools). Reduce painkiller use among youth 12-20 years old. Reduce alcohol use by 12-20 years old. Name of Project: Briefly describe yourself. MINI-GRANT APPLICATION NARRATIVE (DO NOT EXCEED 3 PAGES) 1. Describe your project and how it will benefit youth in your community.
SAPMini-GrantApplicationIndividualREV2014.docx