SAP Applicant Info Form FY19

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Missoula County is now accepting applications for its Substance Abuse Prevention (SAP) mill levy funds for the upcoming Fiscal Year 2019 (July 1, 2018 through June 30, 2019). Deadline for submission is May 16, 2018 at 3 p.m. Download the NOFA to learn what is needed to submit an application.

The form below is the ONLINE Applicant Information Form where applicants enter information directly into website form fields and click submit. This is the ONLINE version of Section A of the application package.

Contact Melissa Gordon at 258-4980 or by email at mgordon@missoulacounty.us if you have questions.

Agency/Organization Information

1
Agency/Organization Name
 *
2
Mailing Address (Street or P.O. Box)
 *
3
Physical address
 *
4
City/Town
 *
5
State
 *
6

Zip code (5 digits)

 *
7
Agency telephone number (format xxx-xxxx)
 *
8
Website
9
Legal status of entity
 *
Legal status of entity
10
EIN (Employer Identification Number)
 *
11
Head of Agency/Organization (First and Last Name)
 *
12
Title
 *
13
Telephone number (format xxx-xxxx)
 *
14

Email address of head of agency/organization

15

Contact Person for this application (First and Last Name)

Please re-type even if the agency head is the contact person for this application.

 *
16
Contact person's title
 *
17
Contact person's telephone number (format xxx-xxxx)
 *
18
Email address of primary contact
 *

Project Information

19
Project Title
 *
20
SYNOPSIS: Maximum 300 characters with spaces or 50 words. Describe the project or program and the beneficiaries (e.g., who are the recipients of your project/program?). Do NOT copy and paste your complete Executive Summary.
 *
21
What substance abuse prevention service(s) will be provided? Check all that apply.
 *
What substance abuse prevention service(s) will be provided? Check all that apply.
22
Total county dollars requested from Substance Abuse Prevention mill levy for Fiscal Year 2019 (whole numbers only; no decimals)
 *
  1. To receive a copy of your submission, please fill out your email address below and submit.
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