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 |
|
|
|
|
|
