AFSF Application

Date: 

Organization: 

Name & Title: 

Office Phone: 

Cell Phone: 

Email: 

Physical Address: 

Mailing Address: 

Social Media Links: 

Amount Requested $: 

Does organization currently offer intervention? 

-- Select -- Yes No

Name of Specific Intervention Program: 

Previously Received Grants from Riverside County: 

-- Select -- Yes No

If so, Indicate the Year and Exact Amount: 

In the last year that you were awarded money, how was that money spent? 

Year the intervention program was started: 

Current Annual Operating Budget $: 

The target audience for this program: 

Age Range of Program's Participants: 

Number of Participants Assisted: 

Program Summary: 

Word count is limited to 300 words or less.  The text fields will not automatically limit the writer but the reviewers will not consider anything longer than a page or 300 words.

Detail how your program combats drug abuse and/or divert gang activity: 

Word count is limited to 300 words or less.  The text fields will not automatically limit the writer but the reviewers will not consider anything longer than a page or 300 words.

Specify how the requested funds will be spent on the intervention program: 

Word count is limited to 300 words or less.  The text fields will not automatically limit the writer but the reviewers will not consider anything longer than a page or 300 words.

Will this grant allow you to expand the program?  

-- Select -- Yes No

If Yes, how many additional participants are expected to receive services? Describe your plans for expansion. 

Word count is limited to 300 words or less.  The text fields will not automatically limit the writer but the reviewers will not consider anything longer than a page or 300 words.

Do you receive direct referrals from a government agency? 

-- Select -- Yes No

If Yes, from what agencies do you receive direct referrals? 

If No, how do school-age children get into your program?

Word count is limited to 300 words or less.  The text fields will not automatically limit the writer but the reviewers will not consider anything longer than a page or 300 words.

Is your program limited to at-risk youth?

-- Select -- Yes No

If no, please describe all the types of groups your agency serves.

Word count is limited to 300 words or less.  The text fields will not automatically limit the writer but the reviewers will not consider anything longer than a page or 300 words.

Do you charge children or their families for the services you provide?

-- Select -- Yes No