Attachment 1-Coalition Involvement Agreements NOFO CDC-RFA-CE20-2003.docx

Attachment 1. Coalition Involvement Agreements Applicants must include one Coalition Involvement Agreement (CIA) for each coalition sector representative. 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 and should be combined into one PDF, titled “Attachment 1 – Coalition Involvement Agreements” and uploaded to www.grants.gov.

General Information

· CIAs must be dated between January 2019 and the deadline for this application.

· CIAs must be hand-signed and hand-dated. Do not use typed/electronic signatures. 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.

Instructions for Completing the CIA Form

Applicant coalitions have two options for meeting this requirement:

Option 1: If your coalition already has 12 hand-signed and hand-dated agreements with each of the required sectors that are dated between January 2019 and the deadline for this application, these can be used in lieu of the CIA templates provided in this NOFO. The following table must be included at the top of each CIA with each of the empty cells filled in.

Insert an agreement for each of the 12 sectors.

“State, Local or Tribal Government Agency with Expertise in the Field of Substance Abuse” Insert Individual’s Name

Ms. Dee F. Cee Insert Organization Name

County Substance Misuse Prevention Council Explain Briefly

Provides support, training, and guidance to prevention service providers and coalitions in the catchment area of the coalition.

NOTE: For the youth sector representative, the member’s age must be listed in the agreement.

Option 2: Use the CIA forms provided below.

Using the headings in the five columns provided below, complete a CIA for each required sector representative. Remove the italicized language and enter the correct information.

Because 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.

Coalition Involvement Agreement (CIA)

CIA Information Table

Youth

Include age of youth in rationale

Youth: An individual 18 years of age or younger (must provide age of youth).

This agreement between [Coalition name] and the Youth Representative, [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 Youth 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 Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Coalition Involvement Agreement (CIA)

CIA Information Table

Parent

Parent: An individual legally responsible for a child, grandchild, or foster child.

This agreement between [Coalition name] and the Parent Representative, [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 Parent 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Business

Business: A representative of a business-related organization.

This agreement between [Coalition name] and the Business Representative, [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 Business 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Media

Media: A representative of a communication outlet that provides information to the community.

This agreement between [Coalition name] and the Media Representative, [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 Media 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

School

School: A representative of the school system with influence in school policies and procedures.

This agreement between [Coalition name] and the School Representative, [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 School 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to peer review.

Youth Serving Organization

Youth Serving Organization: A representative of an organization that provides services to youth.

This agreement between [Coalition name] and the Youth Serving Organization Representative, [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 Youth Serving Organization 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Law Enforcement

Law Enforcement: A representative of a law enforcement agency. The representative must be an active sworn law enforcement officer, not retired.

This agreement between [Coalition name] and the Law Enforcement Representative, [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 Law Enforcement 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Civic/Volunteer Organization

Civic/Volunteer Group: 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.

This agreement between [Coalition name] and the Civic/Volunteer Organization, [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 Civic/Volunteer Organization 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to peer review.

Religious/Fraternal Organization

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.

This agreement between [Coalition name] and the Religious/Fraternal Organization Representative, [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 Religious/Fraternal Organization 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Healthcare Professional

Healthcare Professional: An individual and/or organization licensed to provide physical, mental, or behavioral healthcare services.

This agreement between [Coalition name] and the Healthcare Professional Representative, [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 Healthcare Professional 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

State/Local/Tribal Government

State/Local/Tribal Government: A representative of a government-funded agency with a focus on substance abuse.

This agreement between [Coalition name] and the State/Local/Tribal Government, [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 State/Local/Tribal Government 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.

Other Organization Involved in Reducing Substance Abuse

Other Organization Involved in Reducing Substance Abuse: A representative of a community organization that addresses substance abuse.

This agreement between [Coalition name] and the Other Organization Involved in Reducing Substance Abuse, [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 Other Organization Involved in Reducing Substance Abuse 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.

Official Coalition Representative’s Name Sector Representative’s Name

Official Coalition Representative’s Signature Sector Representative’s Signature

Title Date Title Date

NOTE: All forms must be dated between January 2019 and the deadline for submission of this application. All forms require handwritten signatures and dates or they will be screened out and not move forward to merit review.