Substance Abuse Prevention Program
Request for Proposal - Page 1 of 3

Tables in Sub-Grants A, B and C

Table in Sub-Grants A, B and C

SCHOOL INFORMATION FORM

School Name School Type (Public or Private) Community Percent Low Income and Source* (public schools only) Mobility Rate and Source* (public schools only) Enrollment by Grade Level: Grades 5-12 and Source* Total Enrollment Grades 5-12
North Middle School Public North City 18%
School Report Card
22%
School Report Card
6-220
7-200
8-195
Fall Housing Data
615

Table in Sub-Grant B - Youth Prevention Education

Youth Prevention Education Implementation Table

School/Site Population (Universal or Selected) Grade Level Targeted Estimated Number of Classes Number of Sessions per Class Length of Session (minimum 30 minutes) Session Frequency
e.g., North Middle School 6 8 11 60 minutes 2x per week

Table in Sub-Grant B - Parent/Family Education

Parent/Family Education Implementation Table

School/Site Grade or age levels Type of campaign (norms or communication) Proposed phase to begin (planning or implementation) Implementation frequency
example

Table in Sub-Grant B - Direct Service Grant Summary Table

DIRECT SERVICE GRANT SUMMARY TABLE

Col 1

Direct Service Type

Col 2

# of youth to be served

Col 3

# of youth in geographic area

Col 4

% of youth served (Col 2 /Col 3)

Col 5

# of adults to be served

Col 6

# of adults in geographic area

Col 7

% of adults served (Col 5 / Col 6)

Youth Prevention Education N/A N/A N/A
Parent/Family Education N/A N/A N/A
Mentoring N/A N/A N/A
Communication Campaigns
Optional Activities N/A N/A N/A
Totals

Table in Sub-Grant B - Direct Service Grant Cost Per Participant - All Sites

DIRECT SERVICE GRANT
Cost Per Participant - All Sites

Col 1

Direct Service Type

Col 2

# of youth to be served

Col 3

# of adults to be served

Col 4

Total amount of funds dedicated to approach

Col 5

% of funds dedicated to approach

Col 6

Cost per participant

(Col 2 or 5/ Col 4)

Youth Prevention Education
Parent/Family Education
Mentoring
Communication Campaigns
Optional Activities
Totals