Wood County Opioid Settlement Funding Request for Proposals 2025-2026

Funding Request Application

Provide information about the agency/organization applying for funding.

Question Title

* 1. Name of applying agency, organization, or individual:
Only list an individual's name if the person is not applying on behalf of an organization/agency.

Question Title

* 2. Address of applying agency, organization, or individual:
Include city, state, zip code; only list personal address if agency/organization address is not available.

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* 3. Indicate whether the applicant has non-profit status:

Yes

No

If no, please explain why this application should be deemed eligible for funding

Question Title

* 4. Applying agency/organization main contact:
This person will receive communication from Wood County on the status of the application and additional information as needed.

Main contact name

Main contact phone number

Main contact email

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* 5. Additional contact:
(optional) Additional contact(s) will be copied into communications from Wood County.

Name

Phone number

Email

Question Title

* 6. Additional contact:
(optional) Additional contact(s) will be copied into communications from Wood County.

Name

Phone number

Email