PROBLEM GAMBLING OUTREACH MINI -GRANT PROGRAM

COUNCIL ON CHEMICAL ABUSE

  1. Purpose

The mini-grant program is intended to facilitate a means by which individuals and agencies can educate their local community on issues related to problem and compulsive gambling. The primary objectives are to establish and enhance collaborative relationships and increase awareness and knowledge in the area of problem and compulsive gambling; work collaboratively on system-wide efforts to increase referral and engagement into treatment for problem gambling; and implement activities directed toward changing individual and community norms regarding problem gambling behaviors.

  1. Eligibility Requirements

Eligible applicants are Pennsylvania organizations or individuals with a Federal Tax ID number. Individual applicants may utilize their social security number if they are a private provider. All grant applicants must include a copy of their most recent "Request for Taxpayer Identification Number and Certification W-9 Form" with their application.

  1. Application Timeline

Completed applications are to be accepted on an ongoing basis throughout the fiscal year (July 1-June 30). An applicant can apply for one or more grants per fiscal year up to a total of $5,000.Applications must be receive no less than 60 days before the event. All grant activities must be completed prior to the end of the fiscal year in which the grant was awarded.

  1. Application Submission:

All applications should be submitted in hard copy to:

Council on Chemical Abuse

Attention: Marcia Goodman-Hinnershitz

601 Penn Street, Suite 600

Reading, PA

Electronic submissions via e-mail are not accepted.

E. Award Determination

All mini-grant awards are contingent on the availability of funds. Applications are to be processed on a first come first serve basis.

  1. Invoices

Include the list of proposed payable items with the individual item costs on program letterhead and submit to the Single County Authority(SCA) as soon as the proposed activity or service has been completed.The SCA will only reimburse for actual approved costs incurred.

  1. For rental of facilities (fire halls, churches, etc.) provide either a receipt or copy of a cancelled check.

Ineligible Costs

The following costs are not eligible for reimbursement under the mini-grant program:

1. New construction or capital expenses

2. Staffing for existing services

3. Direct cash payment to recipients of services

4. Alcohol served at any type of event or activity

5. Reimbursement of any treatment services

6. Reimbursement of current employer/employee for time spent on this project

7. Office equipment

8. Purchase of giveaway and promotional items

(such as gift cards, gift baskets, t-shirts, water bottles, tote bags, pens, etc.)

9. Advertising for individual Problem Gambling Treatment Providers

  1. All posters, brochures, printed materials with a problem gambling message must be submitted for approval by the Department. Materials shall be submitted to the SCA’s assigned prevention program analyst a minimum of 2 weeks prior to date needed.
  1. Mini-grants must be entered as a service into PBPS by the SCA. Activities will be entered under a newly created strategy entitled Gambling Mini-Grants utilizing one of the service codes allowable under the strategy: GIN01 Health Fairs (gambling), GIN05 Gambling Speaking Engagement, GAL01 Gambling Free Activities, or GCO07 Gambling Community and Volunteer Training Services. Should your activity not be adequately captured under one of these four service codes, the SCA must seek pre-approval from the Department for your mini-grant activity.

PROBLEM GAMBLING OUTREACH MINI-GRANT APPLICATION

Section A: Individual/Organization Information

  1. Name of Individual/Organization:
  1. Address of Individual/Organization:

StreetCityStateZip CodeCounty

  1. Telephone Number (include area code):
  1. Fax Number (include area code):
  1. Email Address:
  1. Contact Person: Title of Contact Person:
  1. Federal Tax ID #:
  1. CVMU Vendor #:
  1. Type of organization: (Check all that apply)

Community groups/coalitionsCommunity Health Centers

County Government Education- Schools, Colleges, University,

BusinessFaith-Based Group

For-Profit GroupNon-profit Group

Social/human service agencies

  1. Type of event or activity you are requesting the Department sponsor and fund as part of the mini-grant program: (Check all that apply)

Gambling Free ActivityOutreach Event

Speaking EngagementTraining Event

Other: Specify______

  1. Write a concise paragraph of the individual/organization’s current mission.

(This section is to introduce the individual/organization to the review panel.)

Section B: Basic Information

(Note: There may be questions that are not applicable.)

  1. Audience

Who is the target audience? Please explain who you are trying target to reach with this outreach event, product, or activity? Include the rationale for your selection, including whether the activities are designed to address any population health disparities such as race/ethnic target groups, low socioeconomic groups and/or specific populations groups such as teens, seniors, etc.

How many people will the event or activity be able to accommodate and/ or the number of individuals participating to be impacted to the application?

  1. Cost

See budget sheet to show actual costs of items. Include documentation of each line item on the proposed budget. If you are having multiple events submit a separate budget for each event.

  1. Will participants be charged to attend any part of this event or activity?

YesNo

If yes please specify:

b.Will there be any co-sponsors?YesNo

If yes specify who will be co-sponsoring:

c.Will the co-sponsors be funding any portion of the event or activity?

YesNo

If so, what will their contribution?

3. Media

a.Will this event or activity be promoted? YesNo

If yes please specify exactly how it will be promoted:

b.Will there be media coverage at the event or activity? YesNo

If yes please specify exactly what media coverage:

4. Format of Event

a. When and where will this event or activity be held:

Date:

Time:

Location:

Is the facility Americans with Disabilities Act (ADA) Accessible? YesNo

Note: We cannot fund events in facilities that are not ADA accessible.

b. Is this an all- day event or activity:YesNo

c. If there is a registration process for this event or activity, who will handle the registration process?

  1. What will the registration entail? please explain:

e. Will materials or supplies be provided to participants?

YesNo

If yes, what are the materials, what is the source of the materials, and who is paying for it?

f. Will individuals be able to earn educational credits for attending?

YesNo

Which ones are available? (Check all that apply)

Act 48 Credits AMA CreditsCEU’s

Credits for ClergyContinuing Medical CreditsNCPG CreditsPCB credits Social Work Credits Other:Specify______

g. Will there be vendors at this event or activity?YesNo

If yes will they be charged a fee to participate? YesNo

h.What type of vendors will be at this event or activity?

i.Will there be multiple speakers:YesNo

If yes what will the format be if there are multiple speakers:

If you are requesting an Honorarium for a speaker and/or a trainer fee, please include the name and credentials of the speakers and/or trainers.

If you are requesting an Honorarium for a speaker and/or a trainer fee, please include a justification for the dollar amount you are requesting per speaker and/or trainer.

5. Information Dissemination

(Note: If your mini-grant involves printing materials this section must be completed.) (Check all that apply)

What is to be printed? (Check all that apply) BillboardBrochures/ Pamphlets

Bulletin insertsPostersNewsletters

Other: ______

Please note: The SCA shall review and pre-approve all final materials that are going to be printed and distributed to the public. A draft of all proposed printed materials or broadcast media (Public Service Announcements, etc.) must be enclosed with your application. All materials mentioned above must include the Department’s Problem Gambling Hotline number (877-565-2112)and website

Do any of the materials have copyright issues? Yes NoNot Sure

Note: We cannot fund copyrighted materials.

6. Educational Resources

Are you planning on purchasing educational resources:YesNo

Type of resources: (Check all that apply)

BooksBrochures/Pamphlets Cassette Tapes /DVDs/VHS Videos

Computer Software ProgramsCurriculumPosters

Provide a list below of the titles of all proposed educational materials/resources that you wish to purchase:

List and describe in detail each activity, purchase, education, effort, training, etc. that is not addressed elsewhere in the application.

If additional information is required,the SCA will contact you for further information.

As a contractor of the SCA, there is the expectation that you as the contractor understand that the SCA is neutral on the issue of gambling.

Budget Sheet for Event / Cost of Item
Location
Facility Cost
Food/Meals (snacks for breaks, lunch for trainings, etc)
Other: (Specify)
Total Cost for Location / 0
Speaker
Speaker's Honorarium
Speaker's hotel cost *
Speaker's travel cost *
Speaker's- food *
Total Cost for Speaker / 0
Training
Trainer's cost to train
Trainer's hotel cost *
Trainer's travel cost *
Trainer's- food *
Total Cost for Training / 0
Educational Resources
Books
Brochures/Pamphlets
DVD's/ VHS Videos/ Cassette Tapes
Computer Software
Curriculum
Posters
Other: (Specify)
Total Cost for Educational Resources / 0
Advertising and Media
Mailing- Postage
Newspaper advertising
Other (specify):
Total Cost for Advertising and Media / 0
Printing of Materials
Booklets/ Brochures/ Pamphlets
Bulletin Inserts
Manuals
Newsletters
Printing Costs
Posters
Other: (Specify)
Total Cost for Printing of Materials / 0
Anything expenses not listed above:
Grand Total Cost of Event/Activity / 0
* Travel and subsistence shall be reimbursed in accordance with the
requirements of the SCA.