CM-YA Matching Grant Application

1.

I understand that this is a matching grant. Available grant funds cover 75% of the training and licensing costs for 2 years. The
remaining 25% is the responsibility of the awardee as outlined below:

If you are planning to train 1-5 counselors in the treatment model your total matching cost is $1,100 per counselor, per year ($2,200 total for the two year grant period).

If you are planning to train more than 5 counselors your total matching cost is $950 per counselor, per year ($1,900 total for the two year grant period).

Question Title

* 1. Address

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number