CIPGP Application for Funds

Funding from the Problem Gambling Casino Fund is being distributed specifically for effective enhancements in problem gambling/gambling disorder prevention services. For this project up to $20,000 per year, per organization may be requested, with the funds potentially renewable, contingent upon outcomes and availability of funding for up to two years.

Prevention Action Alliance recognizes that as the opportunity to gamble in Ohio grows, so does the need for local communities to implement local solutions. Additionally, Prevention Action Alliance understands the difficulties community partners may have in addressing growing and emerging issues, such as problem gambling. The “Community Integration of Problem Gambling Prevention (CIPGP) Project” will reduce barriers to addressing problem gambling by allowing participants to select their own level of participation, while building capacity for the future.

Question Title

* 1. Organization Name

Question Title

* 2. Contact/ Project Lead

Question Title

* 3. Contact Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 4. Fiscal Officer Information

Name

Agency

Address

Email Address

Phone Number

Question Title

* 5. Federal Tax ID

Question Title

* 6. Requested Funding Amount

Question Title

* 7. Project Narrative – the project narrative should be no more than 2,000 words. The narrative must identify Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) goals you plan to accomplish with the funds.

Question Title

* 8. Capacity – describe the staff, coalition members, or volunteer support you have available; as well as in-kind and other financial support.

Question Title

* 9. Barriers – describe any barriers you foresee to your work and what additional supports PAA can provide; training and technical support will be available at no cost.

Question Title

* 10. Upload Budget Template and Narrative

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 11. Upload W9 or 501(c)3 documentation.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 12. Upload Signed Assurances

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File