4-General Grant Application Form 2026.docx

APPLICATION FORM

Opioid Abatement Community Grant Program General Grant Category ($30,000+)

Instructions: Please review all attached exhibits and guiding documents before completing this form. It is essential that you refrain from deleting any text, tables, or input boxes, as this may cause errors and delay the review process. Please also note that narrative responses should adhere to the specified word limits. Concise, focused answers are appreciated.

Section A. Applicant Information

Organization Name:

Organization Business Type: LLC, 501(c)(3) non-profit, unincorporated, etc.

Federal Tax ID Number:

Date of Incorporation:

Primary Contact Person:

Primary Contact Person Email:

Primary Contact Person Phone Number:

Secondary Contact Person:

Secondary Contact Person Email:

Secondary Contact Person Phone Number:

Organization Mailing Address:

Organization Website:

Section B. Board Member or Ownership Information

Instructions: Please provide detailed information regarding your organization’s leadership structure based on your entity type. Non-profit organizations must list all current board members and their respective roles. For-profit organizations should list the names and titles of all owners, partners, or key executives. For state agencies or local governments, please provide the names and titles of both department or division leadership and the specific program leadership. All listed leadership information must be current as of the application submission date.

Section C. Financial Requirements and Requested Funding

Instructions: General Grant requests must be for $30,000 or more, and the requested dollar amount must exactly match the total amount listed in your attached project budget worksheet. Additionally, you are required to submit proof of financial stability from the previous fiscal year. This requirement can be satisfied by attaching an independent audited financial statement, complete tax returns, an official year-end financial statement, or a formal financial review conducted by a certified professional unaffiliated with your organization.

1. Requested Grant Amount: Enter the total funding amount you are requesting from this grant.

2. Total Project Cost (If Different from Requested Amount): If this project is being co-funded by other sources, enter the total overall cost of the initiative.

3. Independent Financial Review Verification: Have you attached a formal financial review or audit conducted by an independent certified professional who is not affiliated with your organization?

☐ Yes ☐ No

4. Financial Documentation Exception Narrative (If No to Question 3): If you selected "No" above, please explain why an independent financial review is unavailable and describe what alternative documentation you are providing to prove financial stability.

5. Current Year Operating Budget: Enter your organization's total operating budget for the current fiscal year.

6. Three-Year Funding History: Please list all financial support your organization has received over the past three years. For each source, include the funder's name, the total funding amount received, and the specific grant/funding period.

Section D. Organizational Capacity

Instructions: This section assesses your organization's structural capacity to successfully execute the proposed project. Please provide a concise overview of your organization's foundational purpose, primary operations, and operational track record. Ensure all responses remain within the specified word limits.

1. Organizational Mission: State your organization’s mission. (100 words or less)

2. Core Activities and Implementation Experience: Summarize your organization’s core activities and detail your historical experience successfully implementing them. (200 words or less)

Section E. Project Description and Activities

Instructions: This section requires a detailed explanation of your proposed project. Please describe the key elements of your initiative, highlighting how it aligns with your organization's mission and how it addresses the specific needs of your target population. As you answer the following questions, provide comprehensive information regarding the project description, target population, core activities, implementation strategies, and any evidence-based practices utilized.

1. Project Title: What is the name of your project?

2. Project Description: Provide a concise description of your project, clearly stating its primary purpose. (100 words or less)

3. Project Status: Is this a new project or an existing project?

☐ New project (not yet operational) ☐ Existing Project (currently providing services and seeking to expand)

4. Prior Funding: Has this project already received funding from the DOSC or other grant makers?

☐ Yes ☐ No

5. Historical Performance (If “Yes” to Question 4): Please provide a narrative detailing the project's historical performance. Include a summary of key outcomes achieved to date, an analysis of any operational or systemic barriers encountered, and a brief description of how those challenges will be addressed or mitigated in the future. (300 words or less)

6. Target Population: Clearly define and describe your project's target population(s). (100 words or less)

7. Project Activities and Strategy Alignment: Describe the specific activities you will implement during this project. Your response must directly align with the strategies selected in Section F below. (200 words or less)

8. Service Delivery Approach: Is this project based on an evidence-based practice, a promising practice, or an innovative approach? Please explain. (100 words or less)

Section F. Opioid Abatement and Remediation Strategies

Instructions: All proposals must align with at least one established abatement and remediation strategy. Please select the checkboxes for all strategies your project will address; you must select at least one strategy to proceed with your application. For a detailed explanation of each strategy, please refer to the Delaware OARS document, which is available for download in the "Public Files" section of Bonfire.

A. Treatment and Recovery Supports

1. Treatment of Opioid Use Disorder (OUD)

a. ☐ Evidence-based Treatment

b. ☐ Withdrawal Management

c. ☐ Telehealth Access

d. ☐ Mobile Services

e. ☐ Trauma-Informed Care

f. ☐ Quality Improvement & Oversight

g. ☐ MAT Training & Waivers

h. ☐ Workforce Development & Incentives

i. ☐ Curriculum Dissemination

2. Recovery Support

a. ☐ Comprehensive Wrap-around Services

b. ☐ Full Continuum of Care

c. ☐ Medication Access

d. ☐ Community Support & Deinstitutionalization

e. ☐ Peer-Recovery Centers

f. ☐ Successful Recovery Programs & Capacity Building

g. ☐ Community Engagement

h. ☐ Stigma Reduction & Staff Training

i. ☐ Culturally Appropriate Services

j. ☐ Youth Recovery Support

k. ☐ Workforce Development

3. Connections to Care

a. ☐ Healthcare Provider Training and Screening

b. ☐ Emergency Department (ED) Services

c. ☐ Peer Support and Warm Handoffs

d. ☐ Crisis Stabilization Centers

e. ☐ Emergency Medical Services

f. ☐ Comprehensive SBIRT Implementation

g. ☐ Centralized Information

h. ☐ Community Outreach

i. ☐ Targeted Assistance Programs

j. ☐ Youth-Focused Contacts and Programs

k. ☐ Workplace Best Practices

4. Addressing Needs of Criminal Justice-Involved Populations

a. ☐ Diversion and Pre-Trial Services

b. ☐ Treatment While Incarcerated

c. ☐ Reentry and Community Supervision

d. ☐ Critical Time Interventions

e. ☐ Specialized Courts

f. ☐ Professional Training and Systems Capacity

5. Addressing the Needs of Pregnant & Parenting Women and Neonatal Abstinence Syndrome (NAS)

a. ☐ Maternal Treatment

b. ☐ Postpartum Continuum of Care

c. ☐ Infant Care, Monitoring, and Dyad Support

d. ☐ Professional Training

e. ☐ Family Stability

f. ☐ Trauma Care

g. ☐ Child Welfare B. Prevention

1. Prevent Over-prescribing of Opioids

a. ☐ Opioid Prescribing Best Practices

b. ☐ Non-Opioid Pain Alternatives

c. ☐ Dispenser Education

d. ☐ Prescription Drug Monitoring Programs (PDMPs)

e. ☐ Electronic Prescribing and Dispenser Education

2. Prevent Misuse of Opioids

a. ☐ Public Awareness Campaigns

b. ☐ Safe Drug Disposal

c. ☐ Community Coalition Support

d. ☐ Non-Profit and Faith-Based Engagement

e. ☐ Comprehensive School-Based Prevention

f. ☐ Targeted Youth and Family Interventions

g. ☐ Youth Mental Health Prevention

h. ☐ Youth Mental Health Access

3. Prevent Overdose Deaths and Other Harms (Harm Reduction)

a. ☐ Expanded Naloxone Access and Distribution

b. ☐ Naloxone Education and Training

c. ☐ School Overdose Response

d. ☐ Good Samaritan Law Awareness

e. ☐ Syringe Service Programs (SSPs) and Harm Reduction

f. ☐ Infectious Disease Testing and Treatment

g. ☐ Mobile Outreach Services

h. ☐ Harm Reduction Training

i. ☐ Data Tracking and Screening C. Other Strategies

1. First Responders

a. ☐ Fentanyl Safety and Handling Training

b. ☐ First Responder Wellness and Trauma Support

2. Leadership, Planning, Coordination

a. ☐ Strategic Planning and Needs Assessment

b. ☐ Public Accountability and Data Dashboard

c. ☐ Infrastructure and Coordination Investment

d. ☐ Program Oversight and Management

3. Training

a. ☐ Staff Training and Networking

b. ☐ Infrastructure for Cross-System Coordination

4. Research

a. ☐ Program Monitoring and Evaluation

b. ☐ Non-Opioid Pain Research

c. ☐ Service Delivery Improvement

d. ☐ Novel Harm Reduction Research

e. ☐ Supply-Side Enforcement Research

f. ☐ Criminal Justice Deterrence Models

g. ☐ OUD Epidemiological Surveillance

h. ☐ Illicit Market Research

i. ☐ Geospatial Access Analysis

Section G. Project Timeline

Instructions: This section assesses the feasibility of your project schedule. Please provide a narrative overview of your planned project phases, detailing their sequence, key milestones, and implementation timeline.

1. Project Timeline Narrative: Describe your project's timeline in a narrative format, highlighting the key phases and their sequence. (200 words or less)

Section H. Project Location and Target Demographics

Instructions: Please identify the specific geographic regions and populations your project will serve. Select all Delaware counties where your activities will take place, and provide a percentage-based estimate if your programming is allocated across multiple counties (e.g., 75% in New Castle County and 25% in Kent County). Additionally, list the specific zip codes for the benefiting communities. Finally, detail the demographic profile of these target communities, utilizing relevant population statistics such as age, socioeconomic status, health outcomes, and geographic distribution to demonstrate a comprehensive understanding of your service area.

1. Location by County: Select the counties where your project will take place:

☐ New Castle County ☐ Kent County ☐ Sussex County

2. Multi-County Allocation: If your project will operate in more than one county please provide an estimate of how grant-funded programming will be allocated across the service areas (e.g., 75% in New Castle County and 25% in Kent County).

3. Target Zip Codes: Specify the zip code(s) of the communities your project will serve:

4. Target Community Demographic Profile: Detail the demographic profile of the target communities, including relevant population statistics such as age, socioeconomic status, health outcomes, and geographic distribution. (200 words or less)

Section I. Project Evaluation

Instructions: Please outline your framework for measuring project success. Responses must demonstrate how your initiative will achieve a measurable impact on the opioid crisis within the grant period.

1. Program Goals and Measurable Results: Identify the primary goals of your program and describe its expected measurable results, including specific outputs, outcomes, and performance indicators. (300 words or less)

2. Data Collection and Analysis: Explain your methodology for tracking success. Detail how you will collect data (including the specific tools and systems used) and how this data will be analyzed to evaluate your program’s overall effectiveness. (300 words or less)

Section J. Expertise, Experience, and Collaboration

Instructions: Please demonstrate your organization’s capacity to successfully implement the proposed project by detailing your team's qualifications, historical achievements, applied learnings, and strategic partnerships.

1. Organizational Experience and Applied Learnings: Highlight up to three similar projects your organization has completed in the past ten years, including a brief description, key outcomes, and the populations served. Reflecting on these past initiatives, describe the specific lessons learned or improvements made that will strengthen this proposed work. (400 words or less)

2. Project Leadership and External Partnerships: Identify your internal project leadership team and summarize their relevant expertise. Additionally, describe the key external partners or stakeholders essential to this project's success, detailing their specific roles, responsibilities, engagement strategies, and any planned allocation of grant funds. (400 words or less)

Section K. Project Budget, Resources, and Sustainability

Instructions: Please provide a comprehensive overview of your project's financial structure and long-term viability. Your responses should align with the required budget worksheet attached to this application.

1. Budget Narrative: Provide a detailed budget narrative outlining how the requested grant funds will be strategically allocated to support the proposed project's activities and achieve its objectives. (200 words or less)

2. Leveraged and Alternative Funding: Detail any other funding sources, financial contributions, or matching resources that will be used to support this project. If none exist, please specify any current funding gaps. (200 words or less)

3. Long-Term Sustainability and Risk Mitigation: Describe your plan to sustain the project’s impact beyond the grant period. As part of this plan, highlight any potential challenges or funding gaps that could threaten sustainability and explain how you intend to mitigate them. (300 words or less)

Section L. Equity and Community Engagement

Instructions: This section assesses your project's commitment to advancing equity and embedding community voices into your operational model. Please demonstrate your strategies for ensuring accessible service delivery and establishing continuous feedback loops with the populations you serve.

1. Equitable Access and Service Delivery: Describe the specific steps your organization will take to identify and remove barriers to access, ensuring your project’s services and resources effectively reach historically underserved or marginalized populations. (200 words or less)

2. Community Input and Shared Decision-Making: Detail how members of the target community will be actively engaged throughout the project's life cycle. Explain your strategies for gathering continuous stakeholder feedback and incorporating those insights into ongoing program adjustments and decision-making. (200 words or less)

Section M. Capacity-Building and Technical Assistance

Instructions: This section identifies your organization’s professional development and operational support needs. Please outline the specific resources or assistance required to maximize your project's impact and ensure compliance. If your organization requires no additional support, you must provide a brief justification based on your demonstrated operational experience.

1. Operational and Capacity Gaps: Identify any specific areas where your organization requires operational support to successfully execute this grant (e.g., financial management, program evaluation, compliance tracking, staff training, or implementing trauma-informed approaches). (200 words or less)

2. Technical Assistance Delivery Preferences: Specify the delivery models and types of technical assistance that would best support your team in addressing the gaps identified above (e.g., structured workshops, peer-to-peer learning, one-on-one coaching, or direct access to subject matter experts). (200 words or less) image.png