Healthy Families Initiative Form

Name of Organization

Contact Person

First Name

Last Name

Contact Phone

(###)

###

####

Contact Email

Website

If you have a website, please list it here

http://

Youth Intervention

• How is your program a positive, empowering, strength-based, and youth-centered intervention? Please be specific in how your programming is designed to provide a positive intervention at a critical, or vulnerable point in a young person’s life. (500 words or less)

What amount is being requested?

Grants between $500-$75,000 per year for 1-3 years are available

Geographic Criteria

Does this proposal provide services, space or support within the South Lane School District?

Yes

Age Criteria

Does it serve children ages 5 to 18?

Yes

Program Focus

Does this proposal focus on social, emotional, physical, and wellbeing programs* to support children with an emphasis on: (check all that apply, only one yes is needed) *Day care/child care is qualified only if it meets the age and program focus criteria.

Comprehensive Health Education, including physical education and activities

Development & Maintenance of Healthy Relationships, including anti-bullying and increasing empathy

Social & Emotional Wellbeing Services, including mental health

Mentorship of Children and Young People

Partnership

Do you have an active partnership, or plan to create a partnership, with a group that is currently serving this age group so that you can begin in 2022-2023? Please list/ Explain:

South Lane Grant Eligibility Screen

Youth Intervention Grant Eligibility Screen