OFDB Annual Report Crawford County Opioid Settlement Funds Annual Grantee Reporting Form This report is due 12 months from the date you received funding.Contact Name(Required)Organization Name(Required)Date of Application(Required)Email Address(Required) Phone Number(Required)ex. (573) 123-1234How much funding did you receive from the original request?(Required)How much have you spent of it so far?(Required)Were you able to complete the objectives within the budget allocated?(Required)Have you completed the project, yes or no? If yes, can we presume all unused funding be put back into the Opioid Checkbook for future endeavors of this board?(Required)What were your project objectives and what have you accomplished toward those?(Required)Will you be able to complete the service or project within your created timeline?(Required)What were your successes experienced in your goals and objectives?(Required)What challenges have you experienced within those goals or objectives?(Required)Describe indicators in measurable data that can be used to determine if the program was being implemented as intended?(Required)For example county coroners or medical examiners can provide data on opioid involved deaths, emergency medical services agencies can provide data on overdose related calls.How do you feel that the results have impacted the bottom line of the Crawford County opioid prevention effort and/or reduction services?(Required)Applicant's Authorized Signature(Required)By typing your name below, you are agreeing for the typed text to be used as your digital signature on this form.
