RFA Released For Funding For Programs on Prevention Among Youth

Healthy Communities Coalition of Lyon and Storey Counties has released a RFA (Request for Applications) to apply for funding for programs focusing on primary substance use prevention among youth. The full RFA and budget forms can be found below. If you have difficulty downloading the RFA or budget forms below, please email Quinn Cartwright, Healthy Communities Coalition’s Deputy Director (quinn@hcclsc.org), for an emailed or mailed copy. Please note, there will be a bidders conference call held on April 26th, 2019 from 11am – 12pm for individuals with questions on the application. Call in information is listed below.

Topic: Healthy Communities Coaliton of Lyon and Storey Counties’ Bidders Call

Time: Apr 26, 2019 11:00 AM Pacific Time (US and Canada)

Join Zoom Meetinghttps://zoom.us/j/821689746

Dial by your location

+1 646 558 8656 US (New York)

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Meeting ID: 821 689 746

Attachment 4

Healthy Communities Coalition (HCC)

Request for Application (RFA)

State Substance Abuse Primary Prevention (SAPP) Funds

Priority will be given to: 1) direct evidenced based prevention programs for youth that either occur in the school setting or provide transportation to the program from school and 2) holistic in nature to include physical and mental wellness and 3) programs that do not duplicate other existing programs. Please no environmental strategies. If your agency is interested in environmental strategies, contact our office and we will work together on these with other resources. HCC will accept written applications from private not-for-profit organizations and governmental agencies to fund substance abuse prevention programming in Lyon, Storey and Mineral Counties. State Substance Abuse Primary Prevention program funding is made available from the Nevada Division of Mental Health and Developmental Services, Substance Abuse Prevention and Treatment Agency.

Application Specifications at a Glance

Funding Period: July 1, 2019 – June 30, 2023

(Funding will be awarded for a one-year period with the opportunity for continuation in years 2 – 4)

Available Funds: $121,775

Types of Services: Primary Prevention, Substance Abuse Prevention, Evidence Based alternative activities which prevent

substance use.

Target Population: Youth; ages 9-20

Service Area: Lyon, Storey and Mineral Counties

Eligibility: Private not-for-profit organization, 501(c)(3), or local governmental entity

Pre-Application Meeting: Friday, April 26th, 2019 – 11:00 to 11:45am PDT

Letter of Intent Due: Friday, May 10th, 2019 – 5:00pm PDT

Application Deadline: Friday, May 31st, 2019 – 5:00pm PDT

Notification of award: Friday, June 17th, 2019 – 5:00pm PDT



  1. General Information 3

  1. RFA Timeline 5

  1. Funding Limitations, Commitments, Eligibility, and Legal Requirements 6

  1. Application Writing Instructions 7

  1. Application Instructions 7

  1. Application Sections 9

    1. Application Summary Form 9

    2. Organization Overview 9

    3. Proposed Program 9

    4. Collaboration and Sustainability 10

    5. Conflict of Interest Policy Statement 10

    6. Assurances 10

    7. Budget Request and Justification Form 10

  1. Summary of Required Contents, Maximum Scores, and Page Limitations 12

VIII. Grievance Policy 12

  1. Forms and Attachments 13

  1. Letter of Intent 14

  2. Application Summary Form 15

  3. SAPTA Prevention Certification Application 16

  4. Definition of Evidence-Based for Substance Abuse Prevention 17

  5. Scope of Work 20

  6. Conflict of Interest Policy Statement 28

  7. Assurances 29

  8. Budget Request and Justification Form 33

I. General Information


The purpose of this funding is the implementation of evidence-based direct service substance abuse prevention programs, practices, and strategies at the community level (Attachment D). The Substance Abuse Prevention and Treatment Agency’s (SAPTA) currently funded local substance abuse prevention coalitions will issue sub grants to local providers and agencies to implement prevention activities. All activities associated with this funding must be for the implementation of those activities that meet an identified need within the community and are prioritized in HCC’s Comprehensive Community Prevention Plan (CCPP). HCC’s most recent CCPP and needs assessment are available at www.healthycomm.org.

Funding Sources

State Prevention Infrastructure (SPI): The purpose of this funding is the implementation of evidence-based direct service substance abuse prevention programs, practices, and strategies at the community level. All activities associated with this funding must be for the implementation of those activities that meet an identified need within the community and are prioritized in the coalition’s Comprehensive Community Prevention Plan (CCPP).

Substance Abuse Primary Prevention (SAPP): The purpose of this funding is to support prevention activities for both alcohol and other drug abuse, with youth age 9-20 years old, ensuring that state prevention resources fill identified gaps using evidence-based programs, practices, and strategies. All activities associated with this funding must be for the implementation of those activities that meet an identified need within the community and are prioritized in the coalition’s Comprehensive Community Prevention Plan (CCPP).

HCC Priorities for 2019 – 2023

Funding priority will be given to: 1) direct evidenced based prevention programs for school aged youth (not parents) that either occur in the school setting or provide transportation to the program from school and 2) holistic in nature to include physical and mental wellness and 3) programs that do not duplicate existing programs. Please no environmental strategies. If your agency is interested in environmental strategies, contact our coalition and we will work together on these with other resources.

Since the last time Healthy Communities Coalition put out a Request for Application, much has happened in our communities that affect the lives of our families. The unemployment, the loss of insurance for medical care, the reduction of services and government, and the great food insecurity so many of our families are dealing with. These factors have everything to do prevention because our rural families are under more stress than five years ago. The funds we are putting out still have to address reducing risk factors and increasing protective factors for substance abuse BUT we also want you to keep in mind our changing environment.

Our coalition members have moved towards a wellness model to better stretch dollars and to show how many things in community life overlap. What does all this mean for your prevention programs? We are looking for evidenced-based prevention programs that reduce the harms of substance abuse and promote physical and mental wellness. Our community prevention plan includes 8 realms of wellness to help give you ideas. An example is what types of foods are you serving to your youth participants? We would like you to serve healthy snacks. Why? Because eating good food makes kids feel physically better even in the short term. If youth feel better, they are less likely to use. Many evidenced based programs already include mental and physical wellness in them and those may be a great place to start.

SAPTA priorities supported by HCC

  1. Priority 1 – Prevent the onset of childhood and underage drinking and other drug use, reduce the progression of substance abuse, including prescription drugs used illicitly and marijuana; prevent the relapse of substance abuse of those in recovery.

  2. Priority 2 – Support earlier access to prevention by targeting students in high-risk environments needing access to after school activities/programming for youth empowerment

  3. Priority 3 – Create or implement strategies to reduce binge-drinking and drug use in youth under the age of 18 because of the lack of a cohesive local marketing campaign. and young adults up to age 24

  4. Priority 7 – Develop targeted prevention efforts aimed at older adults at risk of developing a dependence on opioids and alcohol

  5. Priority 10 – Focus prevention activities on prescription drugs used for non-medical purposes, or without a prescription

  6. Priority 11 – Develop and strengthen linkages to available resources.

  7. Priority 12 – Focus prevention activities around use of e-cigarettes, including the dangers of use and changes in social norms

  8. Priority 14 – Engage cross-systems expertise, such as educational institutions, first responders, law enforcement, etc., to increase or leverage training and educational opportunities and promote community level change.

Restrictions on Funding

Funding from this grant may not be used for:

  • Purchase or improvement of land; purchase, construct or permanently improve (other than minor remodeling) any building or other facility; or purchase major equipment.

  • Satisfaction of any requirement for the expenditure of non-federal funds as a condition for the receipt of federal funds.

  • Provision of financial assistance to any entity other than a public or nonprofit private entity.

  • Screening, brief intervention and referral to treatment;

  • Education to people in treatment;

  • Death prevention such as suicide or overdose reversal;

  • Purchase of naloxone and the necessary materials to assemble overdose kits and to cover the costs associated with the dissemination of such kits;

  • Enforcement of alcohol, tobacco or drug laws, including compensation for law enforcement officials’ time;

  • Travel to conferences focused on domestic violence, suicide, mental health, or other areas that may involve substance use but which the primary focus is not substance use prevention;

  • Providing inpatient hospital services;

  • Making cash payments to intended recipients of health services. (gift cards must be justifiable as a component of an initiative, activity or event and have prior approval from the Bureau. Gift cards, coupons and incentives are unallowable if they can be turned into cash or used to purchase gas, groceries, alcohol or tobacco products.);

  • Satisfying any requirement for the expenditure of non-federal funds as a condition for the receipt of federal funds (match);

  • Providing individuals with hypodermic needles or syringes so that such individuals may use illegal drugs (unless the Surgeon general of the Public Health Service determines that a demonstration needle exchange program would be effective in reducing drug abuse and the risk that the public will become infected with HIV/AIDS);

  • To provide funding for tobacco only prevention programs.

II. RFA Timeline

Application Released: April 12, 2019

Pre-Application Meeting (see specifics below): April 26, 2019***

Letter of Intent Due: May 10, 2019

Application Due: May 31, 2019 – 5:00 p.m.

Application Technical Review: June 3, 2019

Application Objective Review: June 11, 2019

Grant Awards June 17, 2019

Project Period Begins: July 1, 2019

*** A Pre-Application meeting will be held from 11:00 – 11:45 on Friday April 26th via web conference. Grant Awards will be announced via email by June 17th.

III. Funding Limitations, Commitments, Eligibility, and Legal Requirements

Funding Limitations

This funding is available for a one-year period beginning July 1, 2019, with the opportunity for continuation in years two, three and four. Total funds awarded to Lyon, Storey and Mineral County sub grantees will not exceed $121,775. The sub grantees will be supported through the program implementation portion of the Partnership For Success (PFS), Substance Abuse Primary Prevention (SAPP), and Substance Abuse Prevention and Treatment Block Grant (SAPT BG) to provide evidence-based substance abuse prevention programs, practices and strategies in Lyon, Mineral and Storey Counties with HCC acting as the funding agency.

Applications will be evaluated on a competitive basis to implement evidence-based prevention programs, practices and strategies. 100% of the funding must be spent on programs meeting the criteria outlined in Attachment D: Identifying and Selecting Evidence-Based Interventions.

Funds may be used to support programs, practices, and strategies that will fill service gaps without duplicating existing services or activities at the community level. Funding awards will be determined through technical and objective review processes. All awards are contingent on the continued availability of funds. Non-competitive continuation funding will be available in 2020-2021, 2021-2022, and 2022-2023 to programs in good standing. HCC reserves the right to modify or reject any or all sub-grantees. All sub-grantees must conform to the conditions, guidelines and timelines in this RFA.

Applicant and Sub Grantee Commitments

All applicants must:

A. Submit a Letter of Intent (Attachment A).

B. Implement evidence-based direct service substance abuse prevention programs, practices, and strategies at the community level using the criteria outlined in the “Definition of Evidence-Based for Substance Abuse Prevention” from the State of Nevada Division of Public and Behavioral Health, Substance Abuse Prevention and Treatment Agency (Attachment D).

All sub grantees must demonstrate a commitment to:

A. Meet all programmatic evaluation and data collection requirements as required by HCC and SAPTA.

B. Comply with HCC Minimum Training Requirements.

C. Meet all local, state and federal requirements, as outlined in assurance (Attachment G).


All applicants must meet the following requirements:

  • Must be a private not-for-profit organization, 501(c)(3) or local government entity. Use of fiscal agents is allowed; however, applicants must apply for individual non-profit status within six months of award. A copy of the organization’s Internal Revenue Service letter documenting the 501(c)(3) status will be required prior to allocation of funds. Do not provide as attachment to this application.

  • Must be certified by SAPTA to provide primary prevention services. If an applicant is not certified, they must submit an assurance that an application for certification has been filed with SAPTA (Attachment C). Applicants are not required to pay the $100 certification fee unless their application is approved. For information on certification requirements and applications, contact Meg Matta at (775) 684-4190.

Legal Requirements

HCC and SAPTA are in compliance and require all sub grantees to be in compliance with all local, state and federal laws and regulations. This compliance, which includes civil and human rights laws and regulations, insures that all programs and sub grantees are free from any discrimination. No individual will be excluded from participating in any program, service, or benefit based on his/her race, ethnicity, national origin, sexual preference, disability, age, gender, or religious preference. This funding may not be used to supplant current prevention program activities or support inherently religious activities. It may be used to expand or enhance current program activities.

IV. Application Suggestions

Please consider the following suggestions when preparing the application:

  • Respond to all questions in the order provided.

  • Ensure budget figures are mathematically correct and the justification is clear and descriptive.

  • Do not use jargon specific to your agency or program.

  • Do not assume the objective reviewer is familiar with your organization.

  • Avoid acronyms or clearly describe them when used for the first time.

  • Observe page limits and formatting.

  • Link together sections of the application to create a broad picture of the program you wish to implement.

  • Allow adequate time to secure required signatures.

V. Application Instructions

Applications must be typed and must contain all of the information requested below. The information should be organized in the order listed and each section of the application should begin on a new page. The first page of the application is to be the Application Summary (Attachment B). Incomplete applications will not be reviewed and will be returned for corrections and resubmitted to HCC.

Applications will be returned for correction for the following reasons:

  • Failure to use 12-point font size, single space, and 1” margins.

  • Failure to respond to all sections of the RFA.

  • Submission of incomplete, inaccurate or false information.

  • Submission of an application with excessive typographical errors, misspellings, or grammatical errors.

  • Failure to number pages.

  • Failure to observe page limitations.

  • Failure to use forms provided.

Please note:

  • Copies of all required forms for this RFA are included in the Attachment Section of this document.

  • All forms should be submitted in PDF format

  • Attachments that are not requested in the RFA or sections that exceed page limitations will not be read or reviewed.

  • Applications with handwritten forms will not be read or reviewed.

Any application received after the deadline will be returned unread and will not be considered for funding. All applications must be received by HCC by the deadline. There are no exceptions.

Contact and submittal information:

Quinn Cartwright

Deputy Director


PO Box 517

Dayton, NV 89403

Phone: (775) 246-7550

Fax: (775) 246-7553

VI. Application Sections

A. Application Summary Form; Page Limit — Attachment B; Scoring – 5 Points

  • The Application Summary Form is included in the Attachments Section. The total HCC request must equal the “Total Request” indicated on the Budget Request forms.

  • The Application Summary Form will be the first page of the application and will be the equivalent of a cover page. Do not submit a different cover page or cover letter.

B. Organization Overview; Page Limit – 1/2; Scoring – 10 Points

  1. Describe the organization’s experience specific to providing prevention programming using evidence-based practices. Demonstrate it has an organizational structure, resources, and management procedures capable of implementing the proposed program, practice or strategy.

C. Proposed Program; Page limit – 3; Scoring – 40 Points

  1. Describe the evidence-based program to be implemented, including a website link for reviewers.

  2. Describe the local/regional need for the program based on local data and/or information. Include how proposed program addresses HCC and SAPTA priorities.

  3. Provide a clear definition and description of the geographic area and target population to be served by the program. Specify numbers to be serve, age of program recipients, ethnicity, special populations, etc. Include how the evidence-bases program addressed cultural competency (race, ethnicity, socioeconomics, gender, sexual orientation, etc.).

  4. Describe evaluation methods included with the evidence-based program and other evaluation methods employed by organization to measure program effectiveness.

  5. Create and complete implementation timeline using table below as an example. Be sure to include all steps and time anticipated for completion.














Ex: Purchase curriculum and train staff



Collaboration with XXX agencies to recruit participants



Conduct 6 sessions of program







Evaluation, etc.

  1. Complete SAPTA required Scope of Work (Attachment E). Submit as attachment, not in body of application. Directions for completing Scope of Work are included in attachment.

D. Collaboration and Sustainability; Page limit – 1; Scoring – 15 Points

  1. Describe organization’s current involvement/relationship with HCC or, if none exists, plans to engage in coalition efforts.

  2. Describe collaboration with other community partners specific to the proposed programming, including whether other organizations are conducting this program and how duplication is being avoided.

  3. Describe collaborative efforts to sustain program or leverage other resources.

E. Conflict of Interest Policy Statement; Page Limit–Attachment F; Scoring – 5 Points

  • Applicants are required to read and sign the Conflict of Interest Policy Statement (Attachment F).

F. Assurances; Page Limit – Attachment G; Scoring – 5 Points

  • Applicants are required to read and sign the Assurances (Attachment G).

G. Budget Request and Justification; Page Limit – Attachment H; Scoring – 20 Points

  • The applicant must complete the required budget forms for this specific project (Attachment H). Handwritten forms will not be accepted. If the applicant intends on utilizing other funding to support this effort, please indicate how in the justification section. For example, if rent is already paid by existing revenue, the rent should be shown reflecting the type of funding used to cover the cost. The total amount requested on the Budget Request and Justification Form must match the total amount requested on the Application Summary Form.

  • Additionally, provide information specific to other funding received directly related to proposed program in table below. Be sure to list all funding sources being used.

Budget Category

List Funding Source and Funding End Date




End Date:

End Date:

End Date:








VII. Summary of Required Contents, Maximum Scores, and Page Limitations




A. Application Summary Form


Attachment B

Use as cover page

B. Organization Overview



C. Proposed Program


3 plus Attachment E

D. Collaboration and Sustainability



E. Conflict of Interest Policy Statement


Attachment F

F. Assurances


Attachment G

G. Budget Request and Justification Form


Attachment H plus table

H. SAPTA Prevention Certification Application

(if applicable)


Attachment C



  1. Grievance and complaint process

Organizations whose applications were not funded may wish to appeal the decision by submitting their request in writing to the HCC Director within ten days of receipt of the funding decision. The Director will submit the appeal to the chair of the Objective Review Team and acknowledgement of receipt of the appeal will be sent in writing to the applicant within ten days. If requested, a meeting shall be scheduled between the Executive Board, the chair of the Objective Review Team and the appealing agency within 30 days of receipt of letter of grievance.

IX. Forms and Attachments



Lyon, Storey and Mineral Counties State Prevention Infrastructure Funds


Substance Abuse Prevention and Treatment Block Grant Funds

In order for HCC to properly plan for the review of applications and the allocation of funds, it is necessary to have preliminary notification of your plans. Please submit this Letter of Intent by May 10th, 2019. Fax to (775) 246-7553, scan and email to lselmi@healthycomm.org, or mail to PO Box 517, Dayton, NV 89403.

Name of Agency: ______

Contact Person: Title: ______

Mailing Address: ______

City/State/Zip ________________________________

Telephone: Fax _____________

E-Mail Address:

Proposed Program (if yet determined): _____________

Will you be applying to multiple Coalitions for funding Yes No

If yes, provide name(s) of coalitions: ______

Signature/Title Date



Agency Name: _________________________________________________________________

Agency Contact: _________________________________________________________________

Address: _________________________________________________________________

City, State, Zip: _________________________________________________________________

Telephone: ______________________________ Fax: _________________________

E-Mail: _________________________________________________________________

Total Funding Requested: ____________________________________________________

Proposed Program(s) to be Funded: ____________________________________________________


Service Area of Program(s): ____________________________________________________

________ Applicant is a 501(c)(3) or local government entity

________ Applicant currently is a SAPTA Certified Prevention Provider

Current certification expires: ______________________

________ Applicant is not currently certified, but has submitted an application for certification


________ Applicant is applying to multiple coalitions for funding – if checked provide name of coalition(s), proposed program, and amount requested:




________ Previously funded by HCC

________ New applicant

Director’s Name: _________________________________ Date: ___________________

Director’s Signature: _________________________________________________________________

Board Chair Name: _________________________________ Date: ___________________

Board Chair Signature: _________________________________________________________________




Agency Name:

Mailing Address:

Street/P.O. Box City Zip Code

Site Address:

Street/P.O. Box City Zip Code

Telephone Number: Fax Number:


Program Director’s Name:

Program Director’s Signature: Date:

Application approval by:

Program Operator or Authorized Representative’s Name:

Signature: Date:

These signatures verify the program and its operations are in compliance with all applicable state and federal laws including, if applicable: 42 CFR, Part 2, and HIPAA 45 CFR, Parts 160, 162 & 164.

Check appropriate box:




Coalition Sub-recipient

Administrative Program


Nevada Administrative Codes 458 and the Nevada Revised Statutes 458 establish certification standards.

The non-refundable certification fee is $100.00. Make checks payable to SAPTA and mail to address below.


Attention: Meg Matta

4126 Technology Way, 2nd Floor

Carson City, NV 89706

Phone: 775-684-4190 Fax: 775-684-4185

Agency Use Only

Date Application Received: _______

Date Payment Received: _________

Date Check Cleared:


Nevada Division of Public and Behavioral Health,

Substance Abuse Prevention and Treatment Agency

Definition of Evidence-Based for Substance Abuse Prevention


The Substance Abuse Prevention and Treatment Agency (SAPTA) is committed to the implementation of effective substance abuse prevention programs, strategies, policies, and practices by supporting community coalitions and their partners.

The purpose of this document is to provide program policy for one operational definition and structure for the implementation of Evidence Based Practices by prevention and other SAPTA funded program providers with oversight by community coalitions and/or SAPTA. In addition, this document will guide the prioritization and allocation of funding available through this agency. This program policy is to assist prevention providers certified by SAPTA to implement activities that meet one of the three following definitions for evidence-based prevention practices. Evidence-based practices in prevention are defined by the Substance Abuse and Mental Health Service Administration’s (SAMHSA) Center for Substance Abuse Prevention (CSAP) in their Identifying and Selecting Evidence-Based Interventions Guidance Document (Revised January 2009). According to their definition, an Evidence-Based intervention is defined by inclusion in one or more of the three categories below:

  1. Included in Federal registries of evidence-based interventions; OR

  1. Reported (with positive effects on the primary targeted outcome) in peer-reviewed journals; OR

  1. Documented effectiveness supported by other sources of information and the consensus judgment of informed experts (as specified in the Guidelines that follow), all of which must be met:

Guideline 1: The intervention is based on a theory of change that is documented in a clear logic or conceptual model, AND

Guideline 2: The intervention is similar in content and structure to interventions that appear in registries and/or the peer-reviewed literature, AND

Guideline 3: The intervention is supported by documentation that it has been effectively implemented in the past, and multiple times, in a manner attentive to scientific standards of evidence and with results that show a consistent pattern of credible and positive effects, AND

Guideline 4: The intervention is reviewed and deemed appropriate by a panel of informed prevention experts that includes: well-qualified prevention researchers who are experienced in evaluating prevention interventions similar to those under review, local prevention practitioners, and key community leaders as appropriate (e.g., officials from law enforcement and education sectors or elders within indigenous cultures).


An Evidence-Based Practice (EBP) is defined as a prevention service (program, practice, practice) that has been proven to positively change the problem being targeted. In general, there needs to be evidence that the intervention has been effective at achieving outcomes through some form of evaluation. The evaluation process monitors outcomes to determine whether the intervention positively impacted the target problem and/or contributing condition. The type of evidence collected will vary for different types of interventions. For example, a program will track participants for a period of time after receiving the intervention and compare them to a group who did not participate in the program. An effective practice will be measured by looking at a community that has implemented the practice and the impact that was documented when they did so. Or the impact of the removal of a practice can be studied. Practices are effective if the desired behavior change is supported by everyone in the community.

EBPs are typically accompanied by manuals that prescribe the content delivered to participants for each session and the variations that may be allowed regarding program implementation. The program must be implemented with fidelity to the prescribed delivery. If providers attempt to adjust the program to a different audience, or use a different delivery method, the program will no longer be considered evidence based.

The steps to identify appropriate EBPs include:

  • Identifying a problem and target population

  • Finding relevant research

  • Developing a logic model

  • Implementing a research-informed program

  • Evaluating the outcomes of your program

Evidence Based Programs include evaluation methods, making the evaluation process easier for the provider. Program evaluation may not always show a positive outcome. This does not necessarily mean the program was a failure, but that it was not effective for the problem and target population. Less than positive evaluations provide valuable information that will steer you towards other programs that will work for your community.


While the emphasis on evidence-based practices will continue, there is a need to develop and create new interventions and technologies and in turn, to establish the evidence. In addition to EBP, there are also many promising practices in various stages of development. These are services that have not been studied, but anecdotal evidence and program-specific data indicate they are effective. As these practices continue to be evaluated, the evidence is collected to establish their efficacy and to advance the knowledge of the field.

New strategies may be used if an EBP does not exist to meet the identified community need and there is not one that can be adapted to do so. It is recognized that there may be prevention initiatives that a community is committed to which have not gone through the process to have documented a stronger level of evidence that it is effective. Use of non-evidence-based practices must be justified in writing and approved through the Bureau of Behavioral Health Wellness and Prevention.

Note: SAMHSA terminated the NREPP contract on December 28, 2017 because some of the evidence-based practices were not current. SAMHSA is moving to EBP implementation efforts through targeted technical assistance and training that makes use of local and national experts and will assist programs with implementation. Below is a partial list of popular resources. Applicants are encouraged to do further research to find substance abuse prevention evidence-based programs which will best address your community needs.


SAMHSA’s Evidence-based Practices Resource Center


Office of Juvenile Justice and Delinquency Prevention (OJJDP)


National Institute on Drug Abuse



The NCJA Center for Justice Planning (NCJP)


National Institutes of Health

https://teens.drugabuse.gov/teachers/lessonplans#/questions (new)



National Institute of Justice


Network of Care – Clark County


Refer to categories: Health Risk Factors, and Mental Health and Substance Abuse

Botvin LifeSkills Training


Project Northland and Class Action


Project Towards No Drug Abuse


Too Good for Drugs


Mind over Matter Series


Parenting Wisely


Smart Moves


Catch My Breath


Stanford Medicine Tobacco Prevention Toolkit









PHYSICAL ADDRESS (City, State, Zip):






Brief Description of program:

Problem Statement:

Goal 1:

Outcome Objective 1a:

Activities including Evidence-based Programs

CSAP Codes

Date due by


  1. [Insert activity]

  1. [Insert activity]


Outcome Objective 1b:

Activities including Evidence-based Programs

CSAP Codes

Date due by


  1. [Insert Activity]

  1. [Insert Activity]

  1. [Insert Activity]


Copy and paste pages and tables to add additional goals and objectives.


Service Code

  • Single

  • Recurring

Program Category

  • Evidence Based

  • Non-Evidence Based

Service Population (TARGET POPULATION)

  • SP01 Business & Industry

  • SP02 Civic Groups/Coalitions

  • SP03 College Students

  • SP04 COSAS-Children of Substance Abusers

  • SP05 Delinquent/Violent Youth

  • SP06 Economically Disadvantaged Youth/Adults

  • SP07 Older Adults

  • SP08 Government Elected Officials

  • SP09 Elementary School Students

  • SP10 General Populations

  • SP11 Health Professionals

  • SP12 High School Students

  • SP13 homeless/Runaway Youth

  • SP14 Middle/Jr. High School Students

  • SP15 Parents/Families

  • SP16 People Using Substances

  • SP17 People with Disabilities

  • SP18 People with Mental Health Problems

  • SP19 Physically/Emotionally Abused People

  • SP20 Pregnant Females/Women of Childbearing Age

  • SP21 Preschool Students

  • SP22 Prevention/Treatment Professionals

  • SP23 Religious Groups

  • SP24 School Dropouts

  • SP25 Teachers/Administrators/Counselors

  • SP26 Youth/Minors

  • SP27 Law Enforcement/Military

  • SP28 Gay/Lesbians

  • SP98 Other

  • SP99 Not Applicable


  • Universal Direct

  • Universal Indirect

  • Selective

  • Indicated

Service Type (CSAP STRATEGY)

Information Dissemination-STN

  • STN01 Clearinghouse/Information Resource Center

  • STN02 Health Fair

  • STN03 Health Promotion

  • STN04 Original A/V Material Developed

  • STN05 Original Written (Print/web/pdf) Material Developed

  • STN06 Original Curricula Developed

  • STN07 Original Periodicals Developed (either electronic or print)

  • STN08 Original PSA’s Developed

  • STN10 A/V Material Disseminated

  • STN11 Print/Web/pdf/electronic Materials Disseminated

  • STN12 Curricula Disseminated

  • STN13 Periodicals Disseminated (either electronic or print)

  • STN14 PSA’s Disseminated

  • STN15 Resource Directories Disseminated ( electronic or print)

  • STN16 Media Campaigns Distributed

  • STN17 Speaking Engagement

  • STN18 Telephone/Email Information Services

  • STN19 Data Collection

  • STN20 Info Referral via telephone (Help line)

  • STN21 Staff Development


  • STE01 COSA Groups

  • STE02 Classroom Education Services

  • STE03 Educational Services for Youth Groups

  • STE04 Parenting/Family Management Services

  • STE05 Peer Leader/Helper Programs

  • STE06 Small Group Sessions


  • STV01 Environmental Consultation to Communities

  • STV01 Preventing underage Sale of Tobacco and Tobacco Products

  • STV03 Preventing Underage Alcohol Beverage Sales

  • STV04 Establishing ATOD-Free Policies

  • STV06 Public Policy Efforts


  • STA01 ATOD-Free Social/Recreational Events Attendees

  • STA03 Community Drop-in centers

  • STA04 Community Drop-in Center Activities

  • STA06 Community Services

  • STA07 Youth/Adult Leadership Function

  • STA08 Youth/Adult Mentoring

  • STA09 Academic Enrichment

Problem ID and Referral-STP

  • STP01 Employee Assistance Program Attendees

  • STP02 Employee Assistance Program Participants

  • STP03 Student Assistance Program Attendees

  • STP04 Student Assistance Program Participants

  • STP05 DII/SWI/MIP Program Attendees/ Participants

  • STP06 Prevention Assessment and Referral Attendees

Community Based process-STC

  • STC01 Accessing Services and Funding

  • STC02 Assessing Community Needs

  • STC03 Community/Volunteer Services

  • STC04 Formal Community Teams-Formed

  • STC05 Community Team Activities/ Meetings

  • STC06 Training Services

  • STC08 Technical Assistance Services

  • STC09 Data Collection

  • STC10 Systematic Planning Services

  • STC11 Focus Groups

  • STC12 Site Visit


Community Domain

  • COM01 Availability of Drugs

  • COM02 Availability of Fire Arms

  • COM03 Community Laws and Norms Favorable Toward Drug Use, Firearms, and Crime

  • COM04 Media Portrayals of Violence

  • COM05 Transitions and Mobility

  • COM06 Low Neighborhood Attachment & Community Disorganization

  • COM07 Extreme Economic Deprivation

Family Domain

  • FAM01 Family History of Problem Behavior

  • FAM02 Family Management Problems

  • FAM03 Family Conflict

  • FAM04 Favorable Parental attitudes & Involvement in the Problem Behavior

School Domain

  • SCH01 Academic Failure Beginning in Late Elementary School

  • SCH02 Lack of Commitment to School

Individual/Peer Domain

  • IND01 Early and Persistent Antisocial Behavior

  • IND02 Rebelliousness

  • IND03 Friends Who Engage in the Problem Behavior

  • IND04 Gang Involvement

  • IND05 Favorable Attitudes toward the Problem Behavior

  • IND06 Early Initiation of the Problem Behavior

  • IND07 Constitutional Factors


  • TPR01 Strong Bonds with Family

  • TPR02 Experiencing/ parental monitoring with clear rules of conduct with the family unit and involved parents in lives of their children

  • TPR03 Success in school performance

  • TPR04 Strong bonds with pro-social institutions such as the family, school, and religious organizations

  • TPR05 Adoption of conventional norms about drug use

  • TPR06 Skill building

  • TPR07 Problem solving

  • TPR08 Support

  • TPR09 Empowerment

  • TPR10 Boundaries and Expectations

  • TPR11 Constructive Use of Time

  • TPR12 Commitment to Learning

  • TPR13 Positive Values

  • TPR14 Social Competencies

  • TPR15 Positive Identity

Intervening Variables


  • IVA01 Economic Availability (Pricing)

  • IVA02 Retail Availability

  • IVA03 Social Availability


  • IVP01 Promotional Efforts

  • IVP02 Advertising


  • IVN01 Community Norms

  • IVN02 Social Norms


  • IVE01 Enforcement of Laws, Regulations, Administrative Restrictions

Individual-Level Factors

  • IVI01 Biological Factors

  • IVI02 Social Control

  • IVI03 Social Learning

  • IVI04 General Strain

  • IVI05 Perception of Risk




Per HCC’s Ethics and Conflict of Interest Policies and Procedures, a conflict of interest exists when an applicant agency representative has a professional affiliation or personal or immediate family financial interest, either directly or indirectly, in a contract, business transaction, or other matter that is under consideration by any decision making body of HCC.

In the event of a real or potential conflict of interest, the person involved shall promptly disclose to HCC all relevant facts and circumstances relating to said interest or relationship. If you believe that you have a conflict of interest, please respond below:

1. I, and/or a family member or person with whom I have a close personal relationship, serves as an Executive Board member, or in another similar capacity, with HCC. These representatives are:



2. I am not sure whether I have an official conflict of interest, but I believe the following information may be important:

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

I understand and agree to adhere to the statements above regarding conflict of interest. I understand that disclosing this information will not affect my agency’s ability to secure funding from HCC.

________________________________________ ________________________

Applicant Agency Signature/Title Date



As a condition of receiving subgranted funds from Healthy Communities Coalition (HCC), the Subgrantee agrees to the following conditions:

  1. Subgrantee agrees grant funds may not be used for other than the awarded purpose. In the event Subgrantee expenditures do not comply with this condition, that portion not in compliance will not be reimbursed to the subgrantee or must be refunded to the Coalition.

  1. Subgrantee acknowledges the continuation of this subgrant is subject to and contingent upon sufficient funds being appropriated, budgeted, and otherwise made available by the State Legislature and/or federal sources.

  1. Subgrantee agrees to submit reimbursement requests only for expenditures approved in the spending plan. Any additional expenditure(s) beyond what is allowable based on approved categorical budget amounts, without prior written approval by the Coalition, may result in denial of reimbursement.

  1. Approval of subgrant budget by the Coalition constitutes prior approval for the expenditure of funds for specified purposes included in this budget. Requests to revise the approved subgrant must be made in writing using the appropriate forms and provide sufficient narrative detail to determine justification. Expenses that are incurred without prior Coalition approval may not be reimbursed. The Coalition has the authority to require an amendment for any change, but will generally follow these parameters in the process of determining whether an amendment is needed:

    1. Any overall increases or decreases to the award will require an amendment

    2. All increases to the Personnel category will require an amendment

    3. Any changes to the Scope of Work will require an amendment

    4. As long as there are no changes to the Scope of Work, increases to Personnel, or overall changes to the subgrant amount, minor categorical changes (including shifting funds to previously unfunded categories) can be accomplished as a simple change request

    5. Numerous changes to the budget over the course of the budget period and the nature of the changes could result in the Coalition requiring an amendment

  1. Any changes to the approved subgrant that will result in an amendment must be received 90 days prior to the end of the subgrant period (no later than March 30th) and completed 60 days prior to the end of the subgrant period (no later than April 30th). Amendment requests received after the 90-day deadline will be denied.

  1. Recipients of subgrants are required to maintain subgrant accounting records, identifiable by subgrant number. Such records shall be maintained in accordance with the following:

    1. Records may be destroyed by the subgrantee five (5) calendar years after the final financial and narrative reports have been submitted to the Coalition.

    2. In all cases, an overriding requirement exists to retain records until notified in writing of resolution of any audit questions relating to individual subgrants.

Subgrant accounting records are considered to be all records relating to the expenditure and reimbursement of funds awarded under this Subgrant Award. Records required for retention includes all accounting records and related original and supporting documents that substantiate costs charged to the subgrant activity.

  1. Subgrantee agrees to disclose any existing or potential conflicts of interest, as outlined in the Coalition Conflict of Interest Policy Statement, relative to the performance of services resulting from this subgrant award. The Coalition reserves the right to disqualify any grantee on the grounds of actual or apparent conflict of interest. Any attempt to intentionally or unintentionally conceal or obfuscate a conflict of interest will automatically result in the disqualification of funding.

  1. Subgrantee agrees to comply with the requirements of the Civil Rights Act of 1964, as amended, and the Rehabilitation Act of 1973, P.L. 93-112, as amended, and any relevant program-specific regulations, and shall not discriminate against any employee or offeror for employment because of race, national origin, creed, color, gender, religion, age, sexual preference, disability or handicap condition (including AIDS and AIDS-related conditions).

  1. Subgrantee agrees to comply with the Americans with Disabilities Act of 1990 (P.L. 101-136), 42 U.S.C. 12101, as amended, and regulations adopted thereunder contained in 28 CFR 26.101-36.999 inclusive, and any relevant program-specific regulations.

  1. Subgrantee agrees to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996, 45 C.F.R. 160, 162 and 164, as amended. If the subgrant award includes functions or activities that involve the use or disclosure of Protected Health Information, the Subgrantee agrees to enter into a Business Associate Agreement with the Coalition, as required by 45 C.F.R 164.504 (e).

  1. Subgrantee certifies, by signing this subgrant, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. This certification is made pursuant to regulations implementing Executive Order 12549, Debarment and Suspension, 28 C.F.R. pt. 67 § 67.510, as published as pt. VII of May 26, 1988, Federal Register (pp.19150-19211). This provision shall be required of every sub-grantee receiving any payment in whole or in part from federal funds.

  1. Subgrantee agrees, whether expressly prohibited by federal, state, or local law, or otherwise, that no funding associated with this subgrant will be used for any purpose associated with or related to lobbying or influencing or attempting to lobby or influence for any purpose the following:

    1. any federal, state, county or local agency, legislature, commission, counsel, or board;

    2. any federal, state, county or local legislator, commission member, council member, board member, or other elected official; or

    3. any officer or employee of any federal, state, county or local agency, legislature, commission, council, or board.

d. failure to comply will result in disqualification of future funding and/or termination of current funding.

  1. Coalition subgrants are subject to inspection and audit by representatives of the Mental Health and Developmental Services Division – Substance Abuse Prevention and Treatment Agency, Nevada Department of Health and Human Services, the State Department of Administration, the Audit Division of the Legislative Counsel Bureau or other appropriate state or federal agencies to:

  1. verify financial transactions and determine whether funds were used in accordance with applicable laws, regulations and procedures;

  2. ascertain whether policies, plans and procedures are being followed;

  3. provide management with objective and systematic appraisals of financial and administrative controls, including information as to whether operations are carried out effectively, efficiently and economically;

  4. determine reliability of financial aspects of the conduct of the project; and

  5. chapter 218 of the NRS states that the Legislative Auditor, as directed by the Legislative Commission pursuant to appropriation of public money during any fiscal year. The subgrantee agrees to make available to the Legislative Auditor of the State of Nevada all books, accounts, claims reports, vouchers or other records of information that the Legislative Auditor determines to be necessary to conduct an audit pursuant to NRS 218.

14. Any audit of Subgrantee’s expenditures will be performed in accordance with Generally Accepted Government Auditing Standards to determine there is proper accounting for and use of subgrant funds. It is the policy of the Coalition (as well as a federal requirement as specified in the Office of Management and Budget (OMB) Circular A-133 [Revised June 27th, 2003]) that each grantee annually expending $500,000 or more in federal funds have an annual audit prepared by an independent auditor in accordance with the terms and requirements of the appropriate circular. A copy of the final signed audit report must be sent to the Coalition, within nine (9) months of the close of the Subgrantee’s fiscal year. Failure to comply may result in consequences such as the withholding of reimbursement requests, disqualification of future funding and/or termination of current funding.

The Coalition’s Policy requires that for subgrantees not required to have an audit under OMB A-133, a Limited Scope Audit on Agreed Upon Procedures must be conducted for that year by an independent, licensed Certified Public Accountant, using American Institute of Certified Public Accountants (AICPA) generally accepted auditing standards (GAAS) or attestation standards. A copy of the limited scope report must be sent to the Coalition, within nine (9) months of the close of the Subgrantee’s fiscal year. Failure to comply may result in consequences such as the withholding of reimbursement requests, disqualification of future funding, and/or termination of current funding.

15. Subgrantee shall provide the Coalition with renewal or replacement evidence of insurance no less than thirty (30) days before the expiration or replacement of the required insurance. Subgrantee will provide proof of worker’s compensation insurance as required by Nevada Revised Statutes Chapters 616A through 616D inclusive. Commercial general liability insurance shall be on an occurrence basis and shall be at least as broad as ISO 1996 form CG 00 01 (or a substitute form providing equivalent coverage); and shall cover liability arising from premises, operations, independent contractors, completed operations, personal injury, products, civil lawsuits, Title VII actions and liability assumed under an insured contract (including the tort liability of another assumed in a business contract). The Coalition shall be named as the Certificate Holder on the Certificate of Liability Insurance.

16. Subgrantee agrees to identify the source of funding on all printed and electronic documents

purchased or produced within the scope of this subgrant, using the current Coalition

approved attribution statement that is applicable to the appropriate funding sources.

17. Subgrantees are required to report within 24 hours the occurrence of an incident that may cause imminent danger to the health or safety of the clients, participants, staff of program, or a visitor to the program [NAC 458.153 3(e)]

18. Subgrantee shall adhere to the requirements of the Federal Funding Accountability and

Transparency Act, wherein it stipulates that programs are not eligible for funding unless

they have a Dun and Bradstreet Universal Number System (DUNS) number and maintain

current registration with the Central Contractor Registry (CCR).

19. Subgrantee agrees to comply with the following:

    1. Provide a copy of letters of engagement, audit reports and management letters within 10 days of receipt and acceptance by the organization’s governing authority. This includes a copy of any corrective action resulting from discrepancies identified by the audit;

    2. Be a “smoke, alcohol, and other drug free” environment in which the use of tobacco products, alcohol, and illegal drugs will not be allowed;

    3. Have documentation on file verifying Nevada Repository and FBI background checks were conducted on all staff, volunteers, and consultants, if subgrantee serves minors with funds awarded through this subgrant;

    4. Adopt and maintain a system of internal controls which results in the fiscal integrity and stability of the organization, including the use of Generally Accepted Accounting (GAAP) principles;

    5. Comply with all applicable rules, regulations, requirements, guidelines, and policies and procedures contained within:

      1. 45 CFR Part 74

      2. OMB Circular A-133

      3. Funding source requirements

      4. All other federal rules related to federal funding

      5. Chapter 458 of the Nevada Revised Statutes

      6. Chapter 458 of the Nevada Administrative Code

      7. Mental Health and Developmental Services

      8. Substance Abuse Prevention and Treatment Agency

      9. All applicable state regulations and policies, and

      10. All terms listed within this award

20. Any condition listed within the subgrant award that is not met may result in consequences

such as the Coalition withholding payment of any request for reimbursement,

disqualification of future funding, and/or termination of current funding.

_________________________________ ________________

Signature Administrator Date



Under separate document as budget is created in Excel

Attachment H Budget and Justicication -SAPP (3)pdf

Attachment H Budget and Justicication -SAPP.xlsx

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