Klickitat County Opioid Settlement Funds RFP Application

Klickitat County Opioid Settlement Funds RFP Application
Complete all required applicant information, project details, budgets, assurances, and other elements needed for a complete submission for this RFP.

View the full 2026 Klickitat County Opioid Funds RFP

Download the required budget template here.

You can save the progress of your application at the bottom of the page.
Eligibility Screening
Washington license: Is your organization licensed to provide the proposed services in Washington State?
Service to Klickitat County residents: Does your organization currently serve Klickitat County residents, or will your organization use Opioid Settlement Funds to serve Klickitat County residents?
Does your proposal align with approved opioid abatement strategies, as outlined in Exhibit A, which includes Exhibit A of the One Washington MOU?
Cover Page
Legal Name of Organization
DBA Name (if applicable)
Organization Website
Organization Type
Primary contact name

First NameMiddle NameLast Name
Title
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Applicable License/Certification Number(s), if required
Provide this information only if your organization must be licensed to deliver the proposed services in Washington State.
Tax Identification Number
Total Funding Requested
Project Title
Proposed Service Area within Klickitat County
Authorization and Signature

By signing below, the authorized representative certifies that the information submitted is accurate; the applicant is eligible to contract; proposed costs are not duplicated across funding sources; and, if awarded, funds will be used only for approved purposes and in accordance with the funding agreement. The applicant understands that misuse of funds may result in remedial action, including repayment of improperly spent funds or withholding of future payments.
Authorized Representative Name and Title

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Authorized Representative Email
example@example.com
Authorized Representative Phone
Please enter a valid phone number.Format: (000) 000-0000.
Application Form

Answer every question. Use clear, specific details. Show how the need, activities, results, timeline, and budget connect to each other.
Project Summary, Need, and Approved-Use Fit (250 words maximum)

Describe the project, who it will serve, community need, and how the project fits approved opioid abatement strategies.0/250
Project Activities and Services (250 words maximum)

Describe the services or activities, number of people expected to be served and how you estimated that number, service schedule and locations, and key partners or coordination.0/250
Goals, Timeline, and Results (300 words maximum)

List the project goals, key activities, expected outputs or outcomes, at least three milestones, responsible parties, target dates, and how progress will be tracked.0/300
Experience and partnerships (250 words maximum)

Describe your experience serving this population in Klickitat County, your staff and systems for carrying out the project, and each partner’s role, if any.0/250
Funding and sustainability (300 words maximum)

State whether this request is for a new project, expansion, continuation, or replacement funding. Describe current and other funding, results to date, plans to sustain services, and any requested staff costs.0/300
Budget and Costs (250 words maximum)

Explain major costs, how they support the project, how estimates were made, other project resources, and whether any requested costs are paid by another funding source. 0/250
Budget Form
Complete the Excel Budget Form to show how you will use the funds requested and submit the completed form with your application on Jotform.

Instructions
- Budget Section: Select the appropriate category (direct expenditures, direct program expense, or indirect costs) from the drop-down menu.
- Expense Type: Select the expense type that best describes the cost from the options available for the selected budget section.
- Description/Calculation: Briefly describe the expense, how you calculated it, and how it supports the project.
  - Personnel Costs: For staff costs, list the position or role, pay rate or salary, and time allocated to the project, such as hours or FTE.
  - Indirect Costs: If requesting indirect costs, enter the rate used. Use your approved federal indirect cost rate, if applicable; otherwise, use the de minimis rate permitted by the RFP.
- Amount Requested: Enter the total amount requested for the budget line item. The spreadsheet will calculate totals where formulas are included.
- Approved-Use Code: Select the approved-use code from the Approved Uses tab that applies to this budget line item.
- Project Activity Supported: Identify the project activity or activities supported by this budget line item.
- Intended Outcome: Identify the intended outcome associated with the project activity or activities supported by this budget line item.
- Notes/Justification: Provide any additional explanation needed to support the cost, including justification for travel or food costs that exceed the GSA rate.
Budget Guidelines
- Costs must be reasonable, necessary, and tied to the work described in the application. Provide enough detail for SWACH to understand the request.
- Ensure the total budget amount matches the funding request in your application.
- You may add expense lines as needed.
- Do not change or delete formulas, drop-down menus, or locked cells.
- If you are unsure where an expense belongs, choose the best-fitting category and explain your selection in the Description/Calculation field.
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Klickitat County Opioid Settlement Funds RFP Application

Eligibility Screening

Cover Page

Authorization and Signature

Application Form

Budget Form