Name of Grant Program: Mental Health and Substance Abuse Grant - Competitive
Fund Code: 349
PART III – REQUIRED PROGRAM INFORMATION
Please answer the following questions using no more than ten (10) pages not including the budget pages
(using Arial 10 point font). Applicants must mail two (2) copies of the complete application (see submission
instructions).
District: __________________________________
School(s) that will be the focus of this grant’s work: ____________________________________________
Grant Contact Person___________________________
Title __________________________________
Address: _____________________________________________________________________________
Email_________________________________ Phone Number__________________________________
1. Need for a mental health and substance abuse counselor in the school/school district.

Describe the current school counseling staff and resources currently available to address
mental health and substance abuse related issues.

Describe the school/schools populations to be targeted by the program, the particular needs of
the population including substance use and other related data.
2. Program Design

Provide performance objectives and outcomes for behaviors being addressed based on the
data and the needs provided in the previous section.

Describe the proposed services that will be established or expanded upon by the counselor
position funded through this grant. Information on direct services provided as well as service
provision referrals must be included.

Describe the plan for how the counselor will interact with and impact students in the school or
district

Describe how the funded position will support students academic performance, address social,
emotional, and behavioral health and foster a safe, positive, healthy and inclusive learning
environment for all students.

Provide a description of how relationships with local community based agencies for substance
use and mental health services will be established or enhanced.

Describe strategies for engaging parents as partners in substance abuse and behavioral health
initiatives for children and youth.

Provide a job description that includes roles and responsibilities for the proposed position.
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Name of Grant Program: Mental Health and Substance Abuse Grant - Competitive
Fund Code: 349
3. Fund Use
Describe how the requested funds will be spent, and include the budget and associated budget
narrative forms provided in the Funding Opportunity RFP’s Required Forms section. Funds must be
used to support a mental health and substance abuse counselor for students.
4. Project Timeline
Indicate anticipated dates regarding the proposal. Include timeframes for details such as hiring, inservice training, and implementation of services to students.
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