Thank you for applying for an ICAN mini grant, with funding through DMHA!  All applications are due by September 6, 5:00 p.m.  Applications will be reviewed and scored by a panel and awards will be made based on those scores.  Grantees will be notified by September 13th.  Please contact Lisa Hutcheson at lhutcheson@mhai.net if you have any questions. 

Question Title

* 1. Name of Institution

Question Title

* 2. Name of project coordinator:

Question Title

* 3. Contact Email:

Question Title

* 4. Contact Phone Number:

Question Title

* 5. Please tell us about the need for this program - the PROBLEM you plan to address(you can use as many data sources as you need, but please include the ICAN survey data if your campus participated)

Question Title

* 6. Please tell us about the what RISK and PROTECTIVE FACTORS you are addressing. You can find more information about risk and protective factors here: https://youth.gov/youth-topics/substance-abuse/risk-and-protective-factors-substance-use-abuse-and-dependence.  Please list at least 2 risk and protective factors that your program(s) will address.

Question Title

* 7. Please tell us about the prevention intervention, or PROGRAM(s), that you will be implementing (at least one must be evidence based and taken from NREPP, College AIM, or DMHA EBP list.  If you do not include an EBP, you will not be eligible for funding). You can also include "promising practices" of you have data that shows that your program has been effective on your campus.

Question Title

* 8. Please tell us about your expected changes, or OUTCOMES, listing at least one short term outcome and one long term outcome. These outcomes should include numbers or percentages.

Question Title

* 9. Please tell us how much funding you are requesting (please be aware that all funding must be spent by June 30, 2020). All copies of  receipts related to your program(s) must be submitted with your final report.

Question Title

* 10. Please provide us with a detailed budget. As a reminder, NONE of the mini grant funding can be used for food, snacks, beverages OR incentives for students that are equivalent to cash (gas cards, gift cards etc.).  You can use this funding for "give away" items such as t-shirts, stress relief items, electronic items such as flash drives, etc.  PLEASE contact ICAN if you have questions about your budget and what the funding can be used for.

Question Title

* 11. Grant recipients are required to collect and report NOMS data (sex, age, race, ethnicity, etc) for each program related activity.  Please tell us how you will collect this data for reporting.

Question Title

* 12. Please tell us what other organizations or agencies you will be partnering with on your campus or in your community (check all that apply):

Question Title

* 13. Should you be awarded a mini-grant, the program coordinator or someone familiar with your proposal will be required to attend the ICAN annual meeting, which can be written into your budget to cover travel costs  (only 10% of your budget or up to $300 can be used for travel to the meeting).  Is someone from your campus able to attend this meeting to present on your grant?

T