Douglas County Opioid Settlement Funds Grant Application
Grant Year: October 1, 2025 – September 30, 2026.
Section 1: Organization Information
1. Organization Name:
Please provide the full legal name of your organization
2. Organization Information:
Please describe your organization's incorporation structure and background (e.g., non-profit, governmental agency, etc., and a brief history).
3. Financial Statement/Budget Upload:
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Please upload your most recent annual financial statement or budget.
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Section 2: Funding Request and Project Proposal
1. Amount of Funds Requested:
Please clearly state the specific amount of funding you are seeking. Individual grants will range from a minimum of $5,000 to a maximum of $25,000.
2. Proposed Use of Funds:
Provide a detailed description of how your organization plans to utilize the requested grant funds.
3. Outcomes:
Outline the anticipated outcomes and impacts of your proposed project.
Section 3: Compliance
Compliance Statement:
*
I confirm that our entity and proposed use of funds are in compliance with all provisions in the attached Funding Eligibility & Requirements document.
Funding Elibity & Requirements Document
Section 4: Annual Reporting Requirement
It is required to submit an annual report providing the use of and expenditure of funds along with the resulting outcomes and impact from the grant funds. Please confirm your compliance with this requirement.
Compliance Confirmation
*
I confirm our understanding and compliance with the annual reporting requirement.
Section 5: Prior Grantee Information (If Applicable)
Did your agency receive funds from Douglas County during the grant period beginning in 2023?
Yes
No
2023 Grant Period Annual Report Upload:
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If your agency received funds during the grant period beginning in 2023, you must submit an annual report for those previously granted funds along with your current request for additional funding. File attachments limited to 10mb.
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Section 6: Agreement and Submission
By submitting this application, I confirm that all information provided is accurate and truthful. I understand that if awarded, my organization will be responsible for submitting an annual report detailing the actual use of the granted funds and the outcomes achieved.
I understand
Submission Deadline: August 31, 2025
Phone Number
Please enter a valid phone number.
Email
example@example.com
Additional Attachments:
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You may attach supplemental information here, such as additional financial statements, letters of support, or detailed project plans. File attachments limited to 10mb.
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