Attachment 1_Coalition Involvement Agreements.docx
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- CDC-RFA-CE20-2004CC21
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Attachment 1. Coalition Involvement Agreements
Applicants must include one Coalition Involvement Agreement (CIA) for each of the following coalition sector representatives.
| Sector |
| Definition |
| Youth |
| An individual 18 years of age or younger (must provide age of youth) |
| Parent |
| An individual legally responsible for a child, grandchild, or foster child. |
| Business |
| A representative of a business-related organization. |
| Media |
| A representative of a communication outlet that provides information to the community. |
| School |
| A representative of the school system with influence in school policies and procedures. Youth-serving organization |
| Youth-serving organization |
| Youth Serving Organization: A representative of an organization that provides services to youth. |
| Religious/Fraternal organization |
| A representative of a faith-based organization or representative from a fraternal organization that is based on a common tie or pursuit of a common goal. The organization must have a substantial program of fraternal activities. |
| Law enforcement |
| A representative of a law enforcement agency. The representative must be an active sworn law enforcement officer, not retired. |
| Civic/Volunteer groups |
| A representative of an organization that provides civic or volunteer activities that serves the community (not a coalition member). Examples include Lions Clubs, Rotary Clubs, etc. |
| Healthcare professional or organization |
| An individual and/or organization licensed to provide physical, mental, or behavioral healthcare services (i.e., primary care, hospitals, etc.). |
| State, local, or tribal governmental agency with expertise in the field of substance abuse |
| A representative of a government-funded agency with a focus on substance abuse. |
| Other organization involved in reducing substance abuse |
| A representative of a community organization that addresses substance abuse. |
The following pages provide sample CIAs. By signing a CIA, an individual is affirming that he/she represents a specific sector within the coalition. The 12 completed CIAs indicate compliance with the 12 sectors eligibility requirement. The 12 CIAs should be ordered 1-12 and combined into one PDF. See Section H. Other Information of the NOFO for instructions to upload this attachment.
General Information
· CIAs must be dated between January 2020 and the deadline for this application.
· The same individual cannot sign a CIA as both the sector representative and the coalition representative.
· There must be one completed CIA for each sector. Do not provide more than 12 CIAs. American Indian and Alaska Native applicants may include more than 12 CIAs as needed.
· A coalition sector representative must not represent more than one of the 12 sectors. Choose the individual who best represents each of the 12 sectors.
· Paid coalition staff (current or proposed), such as the Program Director/Principal Investigator (PD/PI), Project Coordinator, and/or the coalition evaluator, and the individual signing as the coalition representative cannot serve as a coalition sector representative.
· CIAs must include a rationale describing why the individual is an appropriate choice for coalition sector representative. This rationale can be brief, but should effectively describe why this individual is qualified for this role.
Instructions for Completing the CIA Form As Attachment 1, complete the Sector Table below and include with a completed CIA for each of the identified sector representatives. The sector representatives identified on the Sector Table must match the CIA provided as part of the DFC application. Include the name of the organization the individual represents as well as a strong rationale for why the individual represents the specific sector they represent in the coalition. The Selection Rationale must include the sector affiliation and justify how the individual selected fits the definitions outlined above.
When completing the CIA, remove the italicized language and enter your coalition’s information. The CIA is an agreement between the coalition and the selected sector representatives, the applicant should identify the agreed upon responsibilities for both the coalition and the sector representative. A CIA is required for each sector representative identified in the Sector Table.
If your coalition already has signed and dated agreements with each of the required sectors that are dated between January 2020 and the deadline for this application, these can be used in lieu of the CIA sample format provided in this NOFO. However, please make sure to complete the Sector Table provided below and include as Attachment 1 with the 12 CIAs.
I. Sector Table
| Sector |
| Sector Representative Name |
| Organization Name |
| Selection Rationale |
| CIA? |
Youth*
Parent
Business
Media
School
Youth Serving Organization
Religious/Fraternal organization
Law enforcement
Civic/Volunteer groups
Healthcare professional or organization
State, local, or tribal governmental agency with expertise in the field of substance abuse
Other organization involved in reducing substance abuse
*NOTE: For the youth sector representative, the member’s age must be listed in the agreement.
Coalition Involvement Agreement (CIA)
This agreement between [Coalition name] and the [Name of sector], [Name of sector representative] shall be from [Month/Date/Year] until terminated by a mutual accord. This agreement will be reevaluated by both parties on a yearly basis.
NOTE: Any items listed below should be unique to the sector representatives and/or the affiliated organization.
[Coalition name] will be responsible for:
1. Creating and following by-laws and policies.
2. Formulating coalition goals and objectives.
3. Overseeing operations of activities, programs, and paid staff.
4. Increasing new membership of the coalition.
5. Creating and following a strategic 12-Month Action Plan.
6. Creating a credible and relevant sustainability plan which includes volunteer membership and resources, both financial and material.
7. Respecting the rights of [Coalition name] members to hold their own opinions and beliefs.
8. Other(s), etc.
The [Name of sector] Representative, [Name of sector representative], will be responsible for:
1. Being a community leader amongst the represented sector.
2. Ensuring clear communication between the sector represented and the coalition.
3. Acting as a positive role model for youth, families, and peers.
4. Supporting the coalition’s mission.
5. Attending coalition meetings which are held on a [ ] basis.
6. Participating on at least one subcommittee.
7. Attending coalition sponsored trainings, town hall meetings, and other community events.
8. Contributing to the strategic action planning process.
9. Participating in sustaining the coalition’s capacity, involvement, and goals.
10. Preventing youth substance use through environmental strategies.
11. Using his/her activities as match, if applicable.
12. Other(s), etc.
Official Coalition Representative’s Name Official Coalition Representative’s Signature
Date
Sector Representative’s Name Sector Representative’s Signature
Date
NOTE: All forms must be dated between January 2020 and the deadline for submission of this application. All forms require signatures and dates or they will be screened out and not move forward to merit review. Handwritten and/or electronic signatures are acceptable.
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