Application: Collegiate Action for Professionals (CPA-CAP)

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* 1. Please enter your information

Your Name

Your Title

Coalition/College/Organization

Address

City/Town

State

Zip Code

County

Phone Number

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* 2. If selected, please tell us who will receive the $500 stipend. It can be YOU as an individual or your coalition, college/university, or organization.

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* 3. Who are you representing?

PA College or University

Community Coalition

Other (please specify)

Prevention of Substance and Mental Health Issues

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* 4. As a collegiate professional, or a member of a community coalition, what substance misuse prevention or intervention initiatives have you been involved in with the collegiate population? Please provide a brief description of the initiatives and your role in them.

If you haven't been involved in any specific initiatives yet, what substance misuse prevention or intervention initiatives would you like to implement with the collegiate population and why?

(Please limit response to no more than 250 words)

Collaboration is Key to Prevent Substance and Mental Health Issues

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* 5. Could you provide an example of a collaboration you have initiated or been a part of that attempted to address substance or mental health issues within a collegiate or community setting? Please describe the collaboration, the stakeholders involved, and your role.

If you haven't participated in this type of collaboration, how do you plan to initiate or engage individuals and organizations? Please describe your approach to fostering partnerships and the steps you would take to ensure successful collaborative efforts. Additionally, do you have any support or resources in place that can assist you in building and maintaining these collaborations?

(Please limit response to no more than 250 words)

How Can CPA-CAP Support You?

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* 6. In what ways do you envision this initiative supporting your personal or professional development? Please describe the specific areas in which you believe the initiative can provide valuable support, such as mentorship, skill-building opportunities, access to funding sources, expanded networks, or any other relevant aspects you anticipate benefiting from.

(Please limit response to no more than 100 words)

Applicants are encouraged to attend all 5 sessions of the CPA-CAP program for optimal networking, collaboration, and dialogue. However, attending a minimum of 4 sessions "live" is acceptable and will meet the $500 stipend guideline. Applicants who indicate their commitment to attending all 5 sessions or provide a plan for addressing any potential absence will be given preferential status during the selection process.

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* 7. Are you able to attend all 5 CPA-CAP Sessions? All will be held virtually, on the following dates & times:
Wednesday, August 23rd: 2:00-3:00 p.m.
Wednesday, September 6th: 2:00-3:00 p.m.
Wednesday, October 4th: 2:00-3:00 p.m.
Wednesday, November 1st: 2:00-3:00 p.m.
Wednesday, December 6th: 2:00-3:00 p.m.

Yes

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* 8. If you can't attend all 5 sessions, please briefly share how you will address any potential absence. For example, will you have a team member participating who can cover an absence, will you watch the recording of the missed session, etc.?