Crawford County Opiod Settlement Funding Request Opioid Funds Application CRAWFORD COUNTY—Crawford County is now accepting applications for opioid remediation projects through its Opioid Settlement funding. Businesses, not-for-profit organizations and tax entities serving Crawford County are eligible to apply. Organization InformationOrganization Name(Required)Please input the name of your organization Mailing Address(Required)Street, City, State, Zipcode Contact Person/Title(Required) Phone Number(Required) Email Address(Required) County Priorities AreasPlease select one or more applicable priority areas. The Opioid Settlement Committee established priority categories at a meeting of local stakeholders on April 16, 2024. While there are more classifications than those listed above, Crawford County is giving priority to those providing services in the above listed categories. If not a priority area listed above, please list the approved used section and subsection from Exhibit E, Schedule B of the Missouri Department of Mental Health's Details list of Approved Uses for Opioid Remediation in the box below. Transporation Child and Family Support Services Housing Prevention Education Reentry Services Support Groups Law Enforcement and First Responders Other Project Overview(Required)Please provide a brief description of the project, including an explanation of how the project meets the allowed activities listed in Exhibit E, Schedule B of the Missouri Department of Mental Health's Details list of Approved Uses for Opioid Remediation. If your project falls within one of the county priority areas (Section 1 on page 1), please explain the connection.Statement of Need(Required)Please provide information about why this project is needed and how it relates to the opioid pandemic. (e.g. statistics about the people served, information about community challenges, community involvement, etc.)Program/Project Description(Required)Please provide as much information about the project as you can provide. (e.g. who will benefit, the area it will serve, how it addresses the needs listed in Section III, etc.)Goals & Objectives(Required)Please explain the short-term and long-term goals for the project, how you will meet the goals, and how you will measure the success of the project.TimelinePlease provide a timeline for each step of the process.Activity 1(Required) Projected Date(Required) MM slash DD slash YYYY Activity 2 Projected Date MM slash DD slash YYYY Activity 3 Projected Date MM slash DD slash YYYY Activity 4 Projected Date MM slash DD slash YYYY Activity 5 Projected Date MM slash DD slash YYYY Activity 6 Projected Date MM slash DD slash YYYY Activity 7 Projected Date MM slash DD slash YYYY Activity 8 Projected Date MM slash DD slash YYYY Activity 9 Projected Date MM slash DD slash YYYY Activity 10 Projected Date MM slash DD slash YYYY Budget DetailsPlease provide details on costs of proposed activities, items to be purchased, etc. If purchasing items, please attach purchasing information that identifies specifications, cost estimates, and any other pertinent information.Item Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalItem Description PriceQuantityTotalBudget NarrativePlease provide details about each project cost.AttachmentsPlease provide copies of all available project plans, maps, photos, reports, public hearing information, and any other documentation that supports the statements made within the proposal. Drop files here or Select files Accepted file types: zip, jpg, pdf, png, Max. file size: 10 MB, Max. files: 6. Applicant's Authorized SignatureBy typing your name below, you are providing a digital signature to the following: As the authorized signature for this application and organization, I certify that the project meets the eligible activity guidelines and is not being used for revenue replacement or any other ineligible activity. I understand that,, if the proposal is approved, I will be required to submit additional documentation for the life of the project such as data gathered, invoices/paid receipts, etc. that may be necessary for the county's audit of the funds. Printed Name & Title NameThis field is for validation purposes and should be left unchanged.
