RESPECT! HEALTHY RELATIONSHIPS! POSITIVE CHOICES!!!

Are there some important issues you want to address in your community?

Tell us how you’d do it and you could get up to $2,000 to make it all happen!

Youth Mini-Grant Application

Name of Youth Applicant(s):______
Address:______
City:______State: ______Zip Code:______Phone Number:______

Email Address:                                   @ mm

Name of Adult Partner Organization:______
(Your project must have an adult collaborator and a partner organization)

Address:______
City:______State: ______Zip Code:______

Telephone Number:______

Email Address:                                   @ mm

Please provide a general description of what you would like to do and how you think your project would help your community.

How would you involve other youth in planning and promoting your project? Which adult(s) would you partner with to help reach your community?

In the following questions, you will describe your project activities and goals. Please keep the Six Steps for Healthy Relationships in mind when brainstorming activities. You can find more information on the Six Steps here:

Choose two of the Six Steps for Healthy Relationships and describe how they fit into your project.

Please describe the activity or activities your project would include.

Please describe the specific ways these activities would help your community.

How will you know if your project has accomplished its goals? What is your plan for evaluating your project’s success?

What other groups in your community will support or help you accomplish your project goals?

How do you plan to promote or publicize your project in your community?

Participants must complete their projects by June 15, 2016 and final reports by June 30, 2016. When would you complete each activity you described? (Timeline)

How much money would your entire project require to complete? How would you use your funds?

Category / Item Description / Projected Cost
Supplies
Travel
Media
Personnel
Total:

How much money are you requesting from the ANDVSA Youth-Led Mini-Grant? ______

Will you be available to meet with ANDVSA staff for a check in the week of Feb. 29th-Mar. 4th? Yes__No__

If you are not available on those dates when would be a good time to meet?______

Applicant Signatures: (Required)

Youth Signatures: (You may have more than one)

Adult Signature: (School or Community Based Organization, or Adult Collaborator)

Date: ______