Organization:        Contact:

 Mailing address: address, city, st, zip


 Phone:                                  E-mail:

 Amount Requesting: (maximum $500)                            

 Date(s) of Event:

 Location of Event(s):

 Name of Event:

 Purpose of Event:
   

 Target Audience; Who is this project geared towards?
 

 How many people will be affected by this grant, by age groups?
 preschool - 3rd grade    4th -6th grade    Middle School    High School
 Adult
 Is this a:     a one-time event    an on-going event

 Adult Sponsor Name:

 Sponsor Phone:     Email:

 Narrative:
 Check which prevention strategies you will use to accomplish your objectives.
 Strategies
 Awareness and Information: Providing information at a one-time event. This may     
      include billboards, letters to parents, advertising, presentations to youth that are     
      limited to one-time episodes, public service announcements, and other similar ways
      of delivering a prevention message.
 Education: providing an experience that includes multiple events or presentations in 
      a planned and sequential format and addresses specific learning goals.
 Training: Providing a service that empowers the audience to promote prevention      
      principles and/or implement prevention programs.
 Community Development: Activities that promote the building or growth of the
      general or a specific community to address substance abuse issues. This may        
      include organizing individuals to address a given issue as a group, addressing
      community decision makers to encourage them to be involved in an issue, building
      relationships with other groups with similar interests to work together on a specific
      item, or similar activities to improve the health and vitality of the community.
 Alternative Activities: Sponsoring activities that are held to provide youth options to
      using alcohol.
  Environmental Change: Focusing on the community level and addressing unhealthy
       "normal" behaviors, organizational policies, legislation, and/or enforcement and
       judicial action around substance abuse issues.
 
  Describe even/project using specific details. in  words of less this box will show for the next 7
 
   
 
  Describe how this will reduce underage drinking in Montcalm County.
 
   
 What partnerships do you have? List their roles.
 
   
 How will the success of this event/project be measured?
 
   
 How will your event/project be promoted?
 
   
  List in-kind contributors and their donation. Include value of contribution. |  
  In-kind contributions can be food, facility w/o charge, speakers,                 
  giveaways, cleanup, etc.
 
   

 Describe how youth are involved in the planning and implementation of
 grant.
 
   

 Budget:
 List all expected sources of income (not in-kind contributions)
 
     Amount                                               Sources of Funds

 $                         Proposed MCPUD Funds

 $                       

 $                       

 $                         TOTAL EXPECTED INCOME

•  Income can come from fundraisers, sponsors, foundations, individuals or other   
   sources. Please note if it is committed or pending income.