SATF Funding Application

* Required field

Name of Organization(s) requesting funding: *

Is funding for (check one): *

Program

Project

Event

Name of the above: *

Where will your program, project or event take place? *

Date of program, project or event: *

Briefly state goal(s) and how it aligns with SATF goals of prevention, collaboration and education: *

How will you measure the outcome of your program, project or event? *

Who is your other funding source(s)? *

Will you be receiving at least one half of requested funding from this other source(s)? *

Yes

Can you show evidence of insurance coverage to current Page City requirements? *

Yes

Who are your collaborative partners? (check all that apply and identify. DO NOT identify individuals)

Youth

Parents

Business

Businesses:

Media

Media:

School(s)

School(s):

Religious/Fraternal Org.(s)

Religious/Fraternal Org.(s):

Healthcare Org.(s)

Healthcare Org.(s):

Youth-Serving Org.(s)

Youth-Serving Org.(s):

Civic/Volunteer Group(s)

Civic/Volunteer Group(s):

Prevention Experts (local, county, state, tribal)

Prevention Experts ( local, county, state, tribal):

Government Agencies

Other

Other:

Amount requested: *

Please confirm your signature by typing your full name in the box below.

I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature.

Enter text below. *