VISION
Madison County ASAP has a vision that all young people in Madison County grow up supported and nurtured by their families, schools and community, and become healthy adults who contribute positively to society.
MISSION
Madison County ASAP works with citizens and community organizations to actively promote and educate others in alcohol, tobacco, and other illicit drug prevention and treatment efforts.
NAME OF APPLICANT/GROUP:SPONSOR/CONTACT & TITLE:
STREET ADDRESS:
CITY, STATE, ZIP:
PHONE: / EMAIL:
FAX:
PROJECT TITLE:
AMOUNT REQUESTED:
Have you received ASAP funding in the past?
If so, please list the amount you received.
What type of activity is this. / Enforcement
Prevention
Treatment
PROJECT SUMMARY: (maximum 2 sentences)
SIGNATURE OF APPLICANT/SPONSOR:
DATE / DATE RECEIVED
BY ASAP
FUNDING CYCLE
There are two application cycles for mini grants. Please have applications submitted by the deadline dates.
May 15, 2015 / July 1, 2015 / TBD
November 15, 2015 / January 1, 2016 / TBD
HOW TO APPLY
1. Review the entire packet contents before beginning your application.
2. Complete all sections of the enclosed application and mail to:
Robyn Moreland, Vice Chairperson
Madison County Agency for Substance
Abuse Policy
P.O. Box 1466
Richmond, Kentucky 40476-1466
All application information must be typed. All pages must be numbered with the submitting group’s name. Pages must be one-sided and the font not less than 12 pt. The original application and one copy must be mailed or delivered to Madison County ASAP. No faxed copies will be accepted. All sections of this application must be completed in their entirety.
SCREENING CRITERIA
Proposals will be reviewed based on the following criteria:
1. Fully completed application received by the due date.
2. Budget items that meet requirements.
3. Prior year compliance with meeting the funded proposal requirements.
· If you have questions regarding the application or need assistance with examples, please contact Robyn Moreland at 859-622-6686 or email at
INFORMATION ABOUT FUNDS REQUESTED
Funds must be used to implement the event/program as described in the application.
ASAP funds can NOT be used for: inflatables, rock walls, multiple mini-grant applications for the same event, bullet proof vests for canines, building renovations, park renovations, home drug test kits, Champions start-up funding, furniture, landscaping, weapons, vehicles, and out-of state travel. Agencies may request equipment, however, equipment purchased with ASAP funding may not be OWNED by another agency or entity. Any equipment requested and purchased will remain the property of MC-ASAP and loaned to the requesting agency for specific events.
10% of the total MC-ASAP award is limited to commodity items (such as but not limited to, t-shirts, bracelets, koozies, lanyards, balloons, pencils, and pens).
Each Applicant is limited to $500 per one-time event. On-going treatment / rehabilitation programs are not restricted to the $500 limit.
APPLICANT AGREEMENT
The applicant will provide the Madison County ASAP with the following items:
1. Group Activity Documentation (Newspaper
Articles, meeting agenda, attendance sheets, surveys, pictures, etc.).
2. Final Report submitted when requested.
3. ITEMIZED receipts for all expenditures.
By signing and submitting Madison County ASAP Mini Grant Application, applicant agrees to comply with all terms. Compliance with all above listed requirements will ensure allocation of stipend to the ASAP funded sponsor. Non-compliance of any above listed requirements will result in forfeiture of stipend funds to the Madison County ASAP and will be re-allocated as appropriate.
Mission Statement or Purpose of Group requesting funding:What problem/concern in your community are you attempting to address in applying for this grant?
How do you know this is a problem/concern that needs to be addressed? (ie. survey data, police reports, media reports, etc.). BE SPECIFIC.
Who, if any are collaborative partners on this event/program.
(Examples: Health Department, Regional Prevention Center, FRYSC, etc.)
Where will the event/program take place?
Expected number of participants?
Project description (In less than 150 words, please describe the event/program you are requesting funds for).
What is the expected outcome of this event/program? BE SPECIFIC.
How will you determine if your event/program was effective? (ie. pre/post tests, sign in sheets, press releases, etc.)?
ITEM / DESCRIPTION/CALCULATION / TOTAL
EXAMPLE:
Drug Treatment Co-Pay / $20 per visit X 10 visits per funded year / $200
TOTAL AMOUNT REQUESTED: