Application

JAMESTOWN
SUBSTANCE ABUSE PREVENTION
TASK FORCE

P.O Box 377
Jamestown, RI 02835


JAMESTOWN SUBSTANCE ABUSE PREVENTION TASK FORCE

FUNDING REQUEST FORM

I. A. Date:

B. Name:

C. Postal Address:

D. Phone #:

E. Name and Address of Organization (if any) Seeking Funds

F. Amount Requested:

II A.Title Of Program:

B. Brief Description Of Program (include outline of Activities)

C. Number of Estimated Participants and Age Group to be Served

D. Date(s) of Program:

Time:

Location:

III. A. Purpose of Event or Program (What do you want to Achieve?)

B. Substance Abuse Prevention Component (Please describe)

IV. A. Budget Outline of all Funds to be Used for this Particular Program (Please list all budgeted expenses with appropriate amounts.)

B. Other Sources from which Funding has been Requested and/or Obtained (Please list.)


laurahosley@yahoo.com