McDowell Opioid Settlement Funds Request

McDowell Opioid Settlement Funds Request

Submit application by 5:00PM on November 30th, 2024. Complete the budget template and upload into the application. Project strategies must align with the strategies provided in EXHIBIT A.
Strategy Specific Resources (for Exhibit A)

In keeping with the National Settlement Agreement, opioid settlement funds may support programs or services listed HERE that serve persons with Opioid Use Disorder (OUD) or any co-occurring Substance Use Disorder (SUD) or mental health condition.
Organization Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Primary Contact

Fill in the fields below with the contact information for your organization's primary contact. This is typically the organization CEO or Executive Director, or whoever is in the position to make decisions for the organization or who would be contacted regarding this application.
Name*

First NameLast Name
Title*
Email*
example@example.com
Proposal Information
Please describe the need that exists in addressing substance use disorder in your community. Why is it important?*
How will your work address the need?*
Please describe why your organization is suited to lead the work?*
Request Amount (Maximum Request $50,000.00) Your budget template may outline expenditures exceeding $50,000.00 to provide understanding of the cost of the entire program. If additional funds are available, your application may be considered for an award greater than $50,000.00.*
Budget Template Document

Click HERE to access the budget template spreadsheet. Please make a copy of the budget document and save as a new spreadsheet before inputting your budget information. You may save your budget document and upload below.
Upload Your Budget Template HERE:*

Cancelof
If the full amount of your request is not able to be funded, will your agency/program be able to pursue it’s work with a smaller award?*

YesNo
Please reference Exhibit A to NC MOA and select which strategy or strategies your proposal aligns with (you may select more than one):*

Collaborative Strategic PlanningEvidence-based addiction treatmentRecovery Support ServicesRecovery Housing SupportEmployment-related servicesEarly InterventionNaloxone DistributionPost Overdose Response TeamSyringe Service ProgramCriminal Justice Diversion ProgramAddiction treatment for incarcerated personsReentry Programs
Please describe how your proposal aligns with the priorities you selected.*
Outputs and Outcomes
How will your community be different from this work? Give specific benchmarks/outputs to determine how well this is working. Outputs are items that document the project activities, e.g., trainings/workshops, number of participants, frequency of attendance, types of services provided, documents produced, loan dollars provided, etc.*
Sustainability
Please tell us how you plan to ensure that the activities or outcomes made possible by the funds will be continued. Examples include fee-for-service revenue, longer-term funding commitment from other funders, integration of programming into organization budget, etc.*
By signing below I certify that: This organization does not promote or engage in criminal acts of violence, terrorism, hate crimes, the destruction of any state, or discrimination based on race, national origin, religion, military and veteran status, disability, sex, age, gender identity or sexual orientation, or support of any entity that engages in these activities. Any funds received for this proposal will be used for the stated purpose, and in accordance with the Opioid Settlement Funding strategies outlined in the proposal. This organization agrees to provide required data and information regarding the impact of the project in the community.
Signature*

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McDowell Opioid Settlement Funds Request

Organization Primary Contact

Proposal Information

Outputs and Outcomes

Sustainability