and fill out 2014 YPGA Grant application

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WHAT IS THE YPGA GRANT?
The purpose of the Youth Problem Gambling & the Arts Grant is to empower young adults in Washington State to make healthy choices around
risky behaviors, such as gambling. Each year, at least one student group is selected to produce a program or project using the arts—such as music,
dance, visual, or media arts—that educates their peers and community about youth problem gambling prevention and awareness.
WHY SHOULD I APPLY?
Youth are at a higher risk of developing a problem with gambling than adults. Internet accessibility, on-campus sports betting, and media
sensationalism contribute to this international issue. Problem gambling, if untreated, may lead to an addiction to gambling, which can be as
destructive and devastating as an addiction to drugs or alcohol. Problem gambling awareness helps individuals make smarter, healthier decisions
about gambling as well as establish responsible gambling guidelines.
WHO QUALIFIES?
Any school (public or private high schools and middle schools, colleges, and universities) or youth-based organization in Washington State.
HOW MUCH CAN I RECEIVE?
YPGA Grants range from $500–$5,000.
HOW DO I APPLY?
E-mail, fax, mail, or drop off this application to:
Rachelle Alongi, Communications & Outreach Coordinator
Evergreen Council on Problem Gambling
1929 4th Avenue East | Olympia, WA 98506
360.352.6133 OFFICE | 360.352.4133 FAX
[email protected]
www.evergreencpg.org
WHEN IS MY APPLICATION DUE?
Applications are due by Friday, January 24, 2014. Incomplete applications will not be considered. Application extensions will not be granted.
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YPGA GRANT APPLICATION
ELIGIBILITY & APPLICATION MATERIALS
To be eligible for the Youth Problem Gambling & the Arts Grant:
• Applicants must be a school (public or private high schools and middle schools, colleges, and universities) or youth-based organization in
Washington State.
• Applicants must submit a complete YPGA Grant application by Friday, January 24, 2014.
• The proposed program/project must focus on problem gambling awareness with youth or young adults.
ENSURE YOUR YPGA GRANT APPLICATION IS COMPLETE BY SUBMITTING:
• Grant proposal
• Adult advisor release form
• Youth release form—one for every student participating in program/project
• Project budget
• Brief letter signed by a principal or authorized administrator acknowledging and supporting your program/project
SELECTION
Evergreen Council on Problem Gambling (ECPG) reads and reviews all grant applications. Grants are awarded based on programs/projects that best
fit the YPGA Grant requirements and goals and mission of ECPG. Grant recipients and ECPG will establish a contract in which project deliverables,
final report requirements, and dissemination of funds are determined. Grant recipients will also hold a required grant and awareness orientation
with ECPG before launching their program/project.
QUESTIONS?
Contact:
Rachelle Alongi, Communications & Outreach Coordinator
Evergreen Council on Problem Gambling
1929 4th Avenue East | Olympia, WA 98506
360.352.6133 OFFICE | 360.352.4133 FAX
[email protected]
www.evergreencpg.org
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YPGA GRANT PROPOSAL
Name of school or youth-based organization:
Name of adult program/project advisor:
Address:
City: Day phone: State: Zip:
Cell/Alternate phone:
E-mail address:
What is the theme of your proposed program/project?
What are the ages and grade levels of the youth/young adults involved in this program/project?
Type of program/project: (e.g., music video, dramatic skit, mural, etc.)
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YPGA GRANT PROPOSAL CONTINUED
Start and end date for program/project:
How will you share your program/project with others? (e.g., share the program/project at your school, in your community, social media, etc.)
If your proposal is selected, what times are you and your youth available in February 2014 (and anyone else involved in the program/project) for
your YPGA Grant and awareness orientation? The orientation is required and must take place 1) before program/project begins and 2) after pretest surveys are complete.
If your proposal is selected, will you use other grants or funds for the YPGA Grant program/project? If so, please explain:
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ADULT ADVISOR RELEASE FORM
I,
, agree to serve as the point of contact/adult advisor for a Youth Problem Gambling
& the Arts Grant program/project. As such, I agree to the following (please initial):
1. Each student has turned in the required, signed youth release form.
2. I have included a letter of support from a principal or authorized administrator for my proposed program/project.
3. I understand that if my proposal is selected, ECPG and I will arrange a time in February 2014 to hold the required grant and awareness
orientation, during which students will learn about problem gambling. I understand the orientation will be scheduled prior to the launch
of the program/project, and youth will include information from the orientation as part of the program/project.
4. If my proposal is selected, I agree to use ECPG’s online pre- and post-test surveys. I will administer the pre-test surveys before the
orientation and post-test surveys after the program/project is complete. I also agree to fill out surveys online if students use a hard copy
to complete their survey.
5. The YPGA Grant program/project will give proper attribution to ECPG and Washington State Department of Behavioral Health and
Recovery (DBHR), as outlined in the final YPGA Grant contract.
6. I will spend funds as described in the budget and ensure required reports are submitted on time. Unspent funds will be returned to ECPG.
7. If my proposal is selected, I understand ECPG can cease funding if our YPGA Grant program/project does not satisfy the requirements
outlined in the YPGA Grant contract.
8. I understand I may be asked to provide additional information about my proposed YPGA Grant program/project during the application
process and after, if the proposal is selected.
9. I understand the YPGA Grant program/project may be disseminated in part or in whole, modified or unmodified, throughout and beyond
Washington State. I approve of this distribution.
10. I release all personal and professional rights to the YPGA Grant program/project and expect no compensation beyond the grand funding
outlined in the YPGA Grant contract as a result of use of the program/project.
Print Name:
Date:
Signature:
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YOUTH RELEASE FORM
Dear student or parent/legal guardian:
By signing this form, the student (and parent/legal guardian, for youth under the age of 18), gives permission to participate in a Youth Problem
Gambling & the Arts (YPGA) Grant program/project, sponsored and coordinated by the Evergreen Council on Problem Gambling (ECPG) and
Washington State Division of Behavioral Health and Recovery (DBHR). YPGA Grant programs/projects are funded to create student-to-student and
student-to-community messages about problem gambling prevention and awareness.
Youth are at a higher risk of developing a problem with gambling than adults. Internet accessibility, on-campus sports betting, and media
sensationalism contribute to this international issue. Problem gambling, if untreated, may lead to an addiction to gambling, which can be as
destructive and devastating as an addiction to drugs or alcohol. Problem gambling awareness helps individuals make smarter, healthier decisions
about gambling as well as establish responsible gambling guidelines.
FOR STUDENTS
I,
(student’s name), agree to participate in a Youth Problem
Gambling & the Arts Grant program/project and will share my thoughts and ideas freely, without expectation for compensation. I release all
rights to the project and I give my permission for ECPG and DBHR to distribute replicas of the project throughout Washington State and beyond. I
give permission for my likeness, voice, and/or creative contributions to be replicated in part or in whole, modified or unmodified, as needed for the
purpose of public awareness and education. I also give permission for my likeness, voice, and/or creative contributions to be a part of news media
interviews, marketing efforts, and/or reports related to the YPGA Grant and other education efforts, whether electronic and/or print. (All aspects of
this release cover audio, video, photography, posters, advertising, websites, social media, and other forms of electronic or print communication.)
Signature:
Age:
Date:
FOR PARENTS/LEGAL GUARDIANS (if student is under the age of 18)
I,
(parent/legal guardian’s name), give my permission for my child, (student’s name), to participate in a Youth Problem Gambling
& the Arts Grant program/project. I release all rights to this project without expectation for future compensation and give permission for ECPG and
DBHR to distribute replicas of the project throughout Washington State and beyond. I give permission for my child’s likeness, voice, and/or creative
contributions to be replicated in part or in whole, modified or unmodified, as needed for the purpose of public awareness and education. I also give
permission for my child to participate in news media interviews, marketing efforts, and/or reports related to the YPGA Grant program/project and
other education efforts, whether electronic and/or print. (All aspects of this release cover audio, video, photography, posters, advertising, websites,
social media, and other forms of electronic or print communication.)
Signature of Parent or Legal Guardian:
Date:
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PROJECT BUDGET
This project budget is an optional template. You may use another table/spreadsheet, but a detailed project budget MUST be submitted with your application.
SUPPLIES, MATERIALS, AND EQUIPMENT
$
$
$
$
$
$
Total Supplies: $
SERVICES
$
$
$
Total Services: $
TRAVEL AND CONFERENCE REGISTRATION FEES
$
$
Total Travel: $
OTHER EXPENSES
$
$
$
$
$
Total Other Expenses: $
TOTAL EXPENSES
Total Supplies: $
Total Services: $
Total Travel: $
Total Other Expenses: $
TOTAL BUDGET EXPENSES: $
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